The international growth and influence of bioethics has led some to identify it as a decisive shift in the location and exercise of 'biopower'. This book provides an in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It discusses how club regulation stemmed not only from the professionalising tactics of doctors and scientists, but was compounded by the 'hands-off' approach of politicians and professionals in fields such as law, philosophy and theology. The book outlines how theologians such as Ian Ramsey argued that 'transdisciplinary groups' were needed to meet the challenges posed by secular and increasingly pluralistic societies. It also examines their links with influential figures in the early history of American bioethics. The book centres on the work of the academic lawyer Ian Kennedy, who was the most high-profile advocate of the approach he explicitly termed 'bioethics'. It shows how Mary Warnock echoed governmental calls for external oversight. Many clinicians and researchers supported her calls for a 'monitoring body' to scrutinise in vitro fertilisation and embryo research. The growth of bioethics in British universities occurred in the 1980s and 1990s with the emergence of dedicated centres for bioethics. The book details how some senior doctors and bioethicists led calls for a politically-funded national bioethics committee during the 1980s. It details how recent debates on assisted dying highlight the authority and influence of British bioethicists.
‘PEOPLE CAN CHANGE: YOU HAVE IN YOUR HANDS a tool for changing your life’. 1 The title and first sentence of Dr Andrew Weil's bestseller 8 Weeks to Optimum Health, first published in 1997, encapsulates the style and language used in self-help and health advice literature on both sides of the Atlantic across the second half of the twentieth century. Analysis of this literature reveals cultural preoccupations with notions of balance and efforts to reframe the self under medical direction, as well as concerns about the detrimental effects of modern living on diet and health. More particularly, a key feature of the self-help genre, in relation to diet at least, was a commitment to providing readers with the knowledge and agency necessary to achieve ideal selfhood, health and well-being themselves through what the authors thought to be balanced diets or lifestyles.
Drawing on self-help books that were in the Publishers’ Digest top ten, The New York Times’ bestsellers and books with multiple reprints, this chapter considers the self-help genre as one of the key sources and promoters of thinness, youthfulness, vitality, longevity and health as necessary pillars of twentieth- and twenty-first-century selfhood, but also of the concept of balance as a means of achieving health. More specifically, this chapter draws on the work of popular authors, such as Gayelord Hauser, Robert and Violet Plimmer, Linus Pauling and Robert Atkins, in order to understand the development of preoccupations with healthy eating and diet in both the US and Britain. The self-help books analysed in this chapter were often similar in their promotion of balance as the way to health, but each of the authors used their own expertise and had differing interpretations of balance. The first section explores the historical contexts that enabled self-help and dietary advice to become increasingly popular during the second half of the twentieth century, as well as reflecting on the authors, readers and popularity of self-help books. The second section analyses the manner in which self-help authors promoted themselves, their ideas and their products to the public, and the ways in which they legitimised self-help as a respectable practice in the Anglo-American public sphere. The final main section of the chapter explores the multiple ways in which self-help authors argued that responsibility for health lay with the individual, the language and terms used to empower readers to lose weight and be healthy, and the methods and techniques that self-help authors used to encourage readers to take care of their own health.
Self-help and dietary advice in context
The 1950s marked the beginning of what Eric Hobsbawm refers to as the quarter-century ‘Golden Age’ of the Anglo-Americans, marked by the spirit of post-war reconstruction and a monopoly in production and the growth of consumerism in the Western world. 2 Advances in home and store refrigeration techniques and the growth of expendable income introduced new ways of purchasing, storing and consuming food. 3 As Harvey Levenstein, Warren Belasco and Derek Oddy have argued, in the post-war years there were considerable changes in food processing and manufacturing, with an increasing number of pre-packaged and convenience foods. 4 More importantly, as Claude Fischler argues, during the twentieth century many regions of the developed world underwent a ‘McDonaldization of culture’, in which the major change was ‘a shift toward more individualised, less structured patterns of eating’. 5 Social factors also shaped food consumption. As Derek Oddy has suggested, in Britain ‘single-person households gradually increased’, partly as a product of rising levels of divorce. 6 In addition, shifting food preparation and consumption practices were driven by ‘patterns of daily life … profoundly altered by urbanisation, industrialisation, the entry of women in the workforce, the rise in standard of living, the ubiquity of the automobile, and expanded access to leisure activities, vacations and travel’. 7 Such changes created an increased need for self-sustenance as the number of occasions on which individuals ate outside the home – at school or the workplace, for example – became more frequent.
On both sides of the Atlantic during the middle decades of the twentieth century, there was increased medical, political and popular interest in, and concerns about, balanced diets and lifestyles, degenerative diseases, graceful ageing and optimal nutrition. Driven largely by the conditions generated by interwar economic recession and the ravages of the Second World War, providing better nutrition, fighting cancer and heart disease, reducing obesity and promoting healthy ageing became key targets of state health systems. 8 Often drawing directly on ancient medical formulations of health in Hippocratic and Galenic traditions, as well as on nineteenth-century studies of calories and optimal standards of nutrition by Nicolas Clément and Justus Leibig, early and mid-twentieth-century self-help authors in these areas regularly mobilised notions of balance. Preoccupations with balance in the area of dietary advice reflected a more widespread scientific and clinical interest in the physiology and psychology of balance in the interwar years: as Mark Jackson has argued in his study of stress, ‘the physiology of self-regulating bodies emerged most decisively during the middle decades of the twentieth century’. 9 The significance of balance for health, for example, figured particularly strikingly in the work of Walter Cannon and Hans Selye. Indeed, Cannon's concept of homeostasis, which captured the ability of organisms to maintain stability or equilibrium in the face of changing external conditions, dominated many biomedical accounts of physiological and psychological health as well as popular advice literature. 10
During the post-war years, society – like individuals – was also often construed as ‘unbalanced’ or at risk. As Ulrich Beck argued in his seminal book Risk Society, ‘in advanced modernity the social production of wealth is accompanied by a social production of risks’. 11 Although technology and science offered the potential for new forms of medicine and healthcare, they also brought death and destruction. 12 Many self-help accounts of health and disease emphasised how balance could be achieved by adhering to natural diets. Diseases in the developed Western world, it was argued, were a direct result of ‘unbalanced diets’, such as eating too much and consuming large amounts of fat, sugar or processed foods. Stories of the wisdom of the noble savage, the lifestyle of the Mediterranean grandparent and the longevity of the Japanese elder thus gained new cultural currency in the West in the context of rising rates of chronic degenerative disease and new accounts of risk.
The concept of the self also played a key role in the lives of people in the Western world, as the idea of ‘being’, ‘becoming’ or ‘realising’ yourself through education, leisure and new patterns of consumption became more prominent during the middle decades of the twentieth century. In Chapter 4, Jane Hand argues that in the post-war period diet and exercise were accepted as components of British identity and social worth, as vehicles for self-realisation. At the same time, as Giddens has argued, the process of ‘detraditionalisation’ associated with modernity meant that people increasingly came to rely on forms of expert knowledge and guidance in the construction of new selves through consumption practices. 13 Other factors instilled notions and practices of self-preservation, self-care and self-help, particularly the growing critiques of medical elitism and the power of the food industry. According to Warren Belasco, during the 1960s a counterculture against fast food, processed food and unnatural food spread rapidly: ‘young cultural rebels began to emerge against mainstream foodways … their rebellion deserves careful reconsideration, for it raised important questions about our food system and also suggested serious alternatives, a countercuisine’. 14 Those rejecting mainstream foodways or criticising the power of orthodox medicine often targeted individual moral choice: eating organic and natural products or turning to alternative medicine was necessary to improve health and preserve the natural environment.
The readership of self-help books on diet and nutrition expanded as a result of increasing preoccupations with slim, young bodies and the rise of what Levenstein refers to as ‘Negative Nutrition’, which shifted foods from being regarded in positive terms to becoming dangerous. 15 As Belasco argues, historically salvation of the soul has been more important than the maintenance of healthy and slim bodies. But during the twentieth century it was the body, and not the soul, that became the central focus of efforts to maintain health and promote a positive self-image. The advertisements examined by Jane Hand in Chapter 4 demonstrate how obesity was viewed by the late 1970s. The ugly/beautiful divide and the emphasis on gender and attractiveness made obese bodies not only more visible, but culturally unattractive. As magazines such as Playboy began to sell pleasure and consumption, 16 preoccupations with bodily fitness accelerated the quest, perhaps particularly among the middle-aged and elderly, for optimal diets, supplements and exercise routines that would promote health and longevity. 17 Self-help authors also often directed their advice at women, especially wives and mothers, who bought these books as guides to feeding their families correctly.
The self-help authors explored in this chapter – notably Gayelord Hauser, Robert and Violet Plimmer, Linus Pauling and Robert Atkins – all advocated different diets and possessed different qualifications, but they also had elements in common. They were all scientists or had some connection with medicine or the biomedical sciences, and most of them had reputations and long careers in health-related disciplines. 18 As Matthew Smith has emphasised in his study of the popular allergist, Ben Feingold, many self-help authors in the mid-twentieth century were middle-aged men – at least in their forties and often older – who exploited their status as mature and established scientists to promote their work. 19 For example, Atkins was 41 when Diet Revolution was printed, Hauser was 55 when he published Look Younger, Live Longer, and Robert Plimmer was 62 when Food Values was first seen in bookshops.
As Matthew Smith and Mark Jackson have pointed out in their reflections on the work of authors such as Ben Feingold and Richard Mackarness, many self-help authors were dissatisfied with, and critiquing, the contemporary authority of science. 20 Both Feingold and Mackarness wrote popular books to promote their ideas, often drawing on neo-romantic aspirations to disseminate advice on how readers could restore natural equilibrium to their lives without recourse to conventional medicine. While Plimmer was dissatisfied with inadequate education on nutrition that caused imbalances and deficiencies, Hauser criticised artificial foods that disrupted normal bodily function, Pauling promoted vitamin C supplements to combat deficiency, and Atkins argued that obesity was the result of carbohydrate poisoning which was the product of an imbalance when humans shifted away from ‘natural’ diets.
Most self-help authors were men; if women were involved they were often authors’ wives. Some books in this genre were written by women, such as Let’s Eat Right to Keep Fit (1954) by Adelle Davis and the Beverly Hills Diet (1981) by Judy Mazel, but the genre was dominated by men. Readers of these books, by contrast, were more often women, or at least male authors deliberately targeted women as those responsible for family diet and health. 21 Rima Apple has argued that in the early to mid-twentieth century women were encouraged to adopt and apply scientific knowledge correctly to household duties, or to perform what Apple refers to as ‘scientific motherhood’. 22 However, it is also possible to identify shifts in this pattern. If women – notably wives – were responsible for the health of the household including their husbands, women joining the workforce and rising levels of divorce forced men both to learn more about food, cooking and health and to take care of their own health. Combined with the increasing visibility of professional athletes, performing artists, actors and singers, which brought nutrition, dieting and slimness to the forefront of debates about appearance and performance, these transitions gradually made the self-help genre more inclusive of men.
Many of the self-help books analysed here were bestsellers and their authors often made public appearances in the media, attracting readers from all socio-economic and religious groups. Contemporary debates about an obesity epidemic, concerns about food additives and chemicals, and preoccupations with vitamins promoted public interest in healthy eating and encouraged the sale of self-help books. 23 Post-war Britons and Americans demonstrated the reach of governmentality as they wanted to maintain their health, energy and productivity in line with normative body standards. A fetishism for goods also attracted readers to this genre. Discussing the popularity of dietary advice during the Renaissance, the early-modernist historian of food Ken Albala has argued that a ‘literate audience with enough leisure and money to be choosy about diet appears to have been a prerequisite for the genre to flourish’. 24 Anglo-Americans in the post-war era had an increasing amount of leisure time and disposable income to begin experimenting with advice to eat balanced diets. Healthy eating became more fashionable and readers wanted to display their knowledge of contemporary health foods. Mel Calman, cartoonist for The Times, argued that ‘dieting almost feels like being a member of a club that revolves around calories, effective diets and foreign health foods’. 25 The success of the ‘health food’ industry, Fabio Parasecoli suggests, was the effective imposition on society of the idea that a better body and better health, highlighted by notions such as the ‘Adonis complex’, could both be purchased. 26 According to Jill Dubisch the manner in which ‘health’ food became almost a religion, with its own system of symbols and meanings, reinforced the commodification of healthy and balanced eating. 27 By reading these books and following their advice, readers chose to be part of a wider belief system. As John Coveney has argued, eating well and dieting replaced Christian asceticism in modern Western societies. 28
Some dietary self-help books were targeted at informed audiences, but also at sceptical readers. According to Marion Nestle, the US government actively informed the public about healthy food choices: from home economics being taught in schools, to the promotion of food pyramids and reports from the Surgeon General. This led to what Gyorgy Scrinis has referred to as ‘nutritionism’, a preoccupation with eating correct amounts of micro- and macro-nutrients, which encouraged more people to buy self-help books. 29 Self-help authors eager to promote their diets not only wrote books, but also began to lecture, instruct and debate in public the benefits of a ‘balanced’ diet. Partly through self-promotion to an audience already sensitised to the importance of natural living in an artificial world, writers such as Hauser, the Plimmers and Atkins popularised the promotion of health through self-regulation and agency.
Self-promotion and self-help
The authors analysed in this chapter used their views of what constituted ‘balanced’ diets and lifestyles – but also idealised notions of selfhood revolving around slimness, youthfulness, energy, vitality and longevity – to achieve higher status and notoriety, earn money from book sales, and to promote self-care and self-help as the most important concepts in maintaining health. They thought of themselves as agents of change and education, locating agency at the individual level. Gayelord Hauser was a German immigrant to the US who had suffered from bovine tuberculosis as a teenager, and was cured while in Europe. 30 He claimed that he learned about the healing properties of food in Dresden and Vienna in 1923, which were prominent centres for fringe medicine at the time. 31 Hauser probably undertook his formal education, however, in the Chicago College of Naturopathy and the American School of Chiropractic. 32 Hauser was among the first advocates of whole grains, vitamin supplements and what he called ‘wonder foods’, such as yogurt, brewer's yeast, powdered skimmed milk and blackstrap molasses, which had all the necessary nutrients for an optimal, balanced diet. 33
Hauser styled himself as an ‘Internationally Famous Young Viennese Scientist’. 34 He sparked discontent from the American Medical Association (AMA), because he dismissed one of the most significant scientific initiatives of the time, fortified white bread, as devitalised. In turn the AMA seized copies of Hauser's Look Younger, Live Longer on the grounds that it promoted only one brand of blackstrap molasses. 35 The AMA's investigation of Hauser did not stop his health crusade, however, as he went on to write more than twelve books on food, diet, health and beauty. 36 Hauser referred to himself as a doctor, not of medicine but of natural science, 37 a strategy designed to increase his credibility. In Look Younger, Live Longer, he wrote in a quasi-scientific way, trying to maintain a level of readability appropriate for the general reader, but nevertheless resorting to scientistic terminology and methodology. 38 He also argued that he was qualified to advise because of his ‘great relish for living’, his ‘great relish for people’ and ‘great relish for longevity’. 39 He proudly informed his readers that he had met ‘society leaders, stage and screen stars, statesmen, business executives, sportsmen, writers, philosophers, doctors, artists, scientists, teachers, preachers and – yes – a Civil War veteran’ 40 – an approach that helped to legitimise his methods and promote trust in his advice.
Hauser became a popular public figure, often making appearances in the media and giving lectures; AMA opposition might even have given him greater notoriety. He was one of the bestselling authors in the New York Times for more than a year in 1950 and one of the leading commentators on diet, health and beauty in Europe and the United States in the 1950s and 1960s. 41 Look Younger, Live Longer was popular when it was first published, and it was reprinted multiple times until the 1970s and translated into at least twelve languages. 42 In the UK, the book was published by Faber and Faber, an independent publishing house with a reputation for supporting bold new authors and ideas.
Hauser's diets are considered to be among the first ‘celebrity’ diets, as one of his early followers was Swedish actress and international film star of the 1920s and 1930s, Greta Garbo. 43 Simon Doonan, Creative Ambassador for Barneys, a chain of US department stores famous for its wide range of luxury brands, has commented on Hauser's popularity: ‘His influence was far-reaching … in the 1950s my mother and my blind Aunt Phyllis both joined his cult, albeit trans-Atlantically … they rejected white sugar and white flour and began ladling Brewer's Yeast and molasses down their throats, and mine. They also favoured a rock-hard Hauser-approved breakfast cereal called Fru-Grains, which resembled lumps of charred bark and played havoc with their dentures.’ 44 Carstairs attributes Hauser's popularity to his target audience, which was usually white, healthy and mostly middle-aged women. 45 This segment of the self-help market, Carstairs argues, was eager for knowledge on beautiful ageing and the preservation of femininity in old age: ‘Hauser was … drawing on a significant tradition of men teaching women, especially older women, on how to perform femininity.’ 46 Additionally, Hauser's sexuality may have helped enhance his status as a diet and health authority. Carstairs argues that the ambiguity of Hauser's sexuality intrigued his audience, since ‘gay men, like women, were expected to take a special interest in style and performance’. 47
The authors of Food Values at a Glance were dissimilar to Hauser in many respects. Robert Plimmer and his wife Violet had a more solid claim to scientific credibility: Robert was a biochemist and Violet a biologist, both fields embedded in mainstream biomedical science. 48 Robert's career as a prominent biochemist can be seen in the fact that at the age of 34 he was one of the founding members of the Biochemical Society. 49 His interest in nutrition was stimulated while in the Directorate of Hygiene War Office during the First World War, 50 where his main duty was to analyse common foodstuffs; he published the results in 1921 as Analyses and Energy Values of Foods. 51 Using results from the Army report, Plimmer and his wife published a number of books in the genre of food, diet and health. Like Hauser, Robert Plimmer gave public lectures and made appearances in the popular media, but with far less controversy than Hauser. The credibility of the Plimmers’ Food Values at a Glance, which was reprinted many times between 1935 and 1959, 52 was perhaps enhanced by the fact that it was published by Longman Press, which had a reputation for publishing educational books written by scientific authorities. Violet's frequent appearance in the media as a commentator on food and health was of equal importance to the public image of their books. 53 In the first instance, it demonstrated that science was no longer an exclusively male realm. Secondly, the fact that the primary audience for their books, namely middle- and upper-class women who could afford to buy advice literature in a period of austerity, was being offered advice by both a man and a woman arguably added an element of trust in the nutritional information provided.
Vitamin C and the Common Cold was not strictly a diet book, but its cultural influence was (and still is) great. Its author, Linus Pauling, was one of the most distinguished scientists of the twentieth century. Pauling is the only person to have been awarded two unshared Nobel prizes: the Nobel Prize in Chemistry for ‘his research into the nature of the chemical bond and its application to the elucidation of the structure of complex substances’(1954); and the Nobel Peace Prize (1962) for his efforts to ban nuclear bomb testing. 54 Pauling was thus a respectable scientist but also a pacifist with frequent media exposure, making his claims about vitamin C more credible to the general public. In the UK, as in the US, the government had played an important role in popularising vitamins and nutrition facts since the interwar period. Like their US counterparts, the UK public had already been initiated into the principles of ‘vitamania’ and supplementation through the Food Facts campaign, the National Milk Scheme and the National Loaf. By providing cod liver oil, orange juice and rosehip oil to lactating mothers, infants and young children, the state had prepared the ground for Pauling's success. 55 Equally, in the UK by the 1960s health food stores had begun opening their doors in many cities. Pauling was thus presenting his work to a receptive audience.
Pauling's interest in the health-restoring and health-promoting benefits of vitamin C stemmed from a letter he received from Dr Irwin Stone. Following Stone's advice, Pauling and his wife found that the number of colds they suffered decreased. In 1969, Pauling presented his findings in a lecture at Mt Sinai Medical School. 56 This incident attracted a reporter from the magazine Mademoiselle to ask him whether she could write an article on the information he presented, and Pauling accepted. Pauling's promotion of vitamin C prompted debate. The nutritional expert Dr Frederick Stare responded in another Mademoiselle article by insisting that a thorough study conducted by the University of Minnesota had concluded that vitamin C did not prevent colds. 57 He also declared that Pauling, even though he was a great American man of peace and chemistry, was not an authority on nutrition. However, as Rima Apple has argued, the tendency for Pauling's critics to articulate ‘ad hominem invective weakened their own claims to be objective, dispassionate observers of medical research and undoubtedly attracted even more attention to Pauling and his cause’. 58
Controversy surrounded Pauling for most of his life. His decision to publish his findings in a popular format, for example, was condemned by his academic peers. 59 Even before the publication of Vitamin C and the Common Cold, however, he had experienced professional friction from conservative administrators and trustees because of his circulation of a petition to stop nuclear testing and because he wrote a popular book called No More War! (1958). 60 This forced him to leave the California Institute of Technology (Caltech), where he had worked for nearly forty-two years, to become a research professor at the Center for the Study of Democratic Institutions in Santa Barbara, California. 61 Pauling also faced hostility from within the American Chemical Society due to his choice to use the status he had achieved from earning the Nobel prize to promote pacifism and prevent nuclear testing, leading to his resignation. 62 The rejection Pauling faced, both publicly and privately, institutionally and professionally, made him more passionate than ever about vitamin C and he coordinated his own health crusade, giving interviews, making appearances on television and radio, and researching the role of vitamins in a range of conditions. However, the credibility of his message was compromised by his tendency to exaggerate the effects of vitamin C, which was linked to a grandiose aspiration to eradicate the common cold from human existence, 63 and to advocate the consumption of the vitamin for a wide range of other conditions, including back pain, cancer and the promotion of intelligence. 64
Pauling presented the available data, but also offered his own interpretations and evaluations of research studies. For example, in response to Stare's criticisms, Pauling insisted that:
The study to which Dr. Stare was referring had been carried out by Cowan, Diehl, and Baker … in 1942. When I read this article I found that the study involved only about four hundred students, rather than five thousand, that it was continued for half a year, not two years, and that it involved use of only 200 milligrams of vitamin C per day, which is not a large dose. Moreover, the investigators reported that the students receiving the vitamin C had 15% fewer colds than those receiving a placebo. 65
The restoration of balance in the human body was a central theme in Pauling's work. Pauling argued that human ancestors had traditionally consumed a diet much higher in vitamin C, generating the optimal balanced state for the human immune system. His recommended dosages, though, were much greater than those suggested as optimal by scientific and medical orthodoxy. The solution to the common cold, according to Pauling, was not a gradual increase in the uptake of vitamin C, but the stabilisation of vitamin C levels through the consumption of megadoses of the vitamin, an approach that echoed Galenic treatment of excess humours with bloodletting, purgatives, emetics and diuretics. 66
Pauling's argument about vitamin C penetrated popular culture via television, radio, magazines and later the internet. Recommendations of vitamin C in other self-help books, 67 as well as celebrity endorsements, attracted further attention to vitamin C as a supplement to remedy colds and flu. For example, Sofia Loren told the Daily Mail: ‘The only pill I take is vitamin C – I'm afraid of getting the flu.’ 68 Further support for Pauling came from the food and supplement industries, which used the opportunity to market their products to health-conscious consumers. 69 Some products such as Ribena had been exploiting public beliefs in vitamin C as a ‘protective’ against the cold prior to the publication of Pauling's book, but Pauling's work helped to strengthen their advertising claims. 70 The benefits of vitamin C were incorporated into debates about other health issues, to the point that it was often hailed as a panacea. 71
The final author considered here, Robert Atkins, was perhaps the most controversial of the self-help authors in the field of diet and health. He was a descendant of Russian-Jewish immigrants to the US, and undertook his pre-medical degree from University of Michigan and gained an MD from Cornell's Medical School in 1955. After completing medical training, Atkins chose to specialise in cardiology, serving cardiologist residencies at the University of Rochester's Strong Memorial Hospital and Columbia University's St Luke's Hospital in New York City. 72 According to his biography, written by journalist and author Lisa Rogak, Atkins always wanted to work with patients rather than becoming a researcher. According to Rogak, he also despised hospital politics. Wanting to establish his own medical practice, he worked initially as a freelance cardiologist, acting as an on-call emergency physician. Atkins had an entrepreneurial instinct, opening his first office close to Cornell (and was thus somehow perceived as a Cornell cardiologist) and choosing to cover night shifts as more celebrities and members of the elite from the nearby New York's Theatre district had emergencies in the evening. This allowed Atkins to make connections with people in show business: in 1962, for example, he assisted in an electrocardiogram for the actor Edward G. Robinson.
According to the introduction to Dr Atkins’ Diet Revolution (1972), Atkins's road to fame began when he was battling his own obesity. Atkins tried various diet plans available at the time, but felt that none of them helped him lose weight and that they all promoted unacceptable levels of hunger. On the basis of his own research, Atkins lost twenty-eight pounds in just six weeks. In 1964, in his capacity as a corporate physician, he tested his diet on sixty-five executives working for the American telecommunications company AT&T. Rogak argues that sixty-four of the executives lost weight, and from that moment Atkins's practice began to boom and his diet appeared on live television. This weight loss experiment received a high level of notoriety, encouraging celebrities like Buddy Hackett to consult Atkins for weight loss concerns. Hackett answered the question put by the audience of The Tonight Show with Johnny Carson: ‘You know how I lost this weight? Dr Atkins used to call me every hour and say “Are you eating?”’ 73 By 1970, the popular magazine Vogue had dubbed the Atkins diet ‘the Vogue Diet’, and Atkins became an international diet icon. 74
Atkins's own narrative account of how he discovered his diet drew on a tradition of the scientist as detective. He had researched past medical journals, where he found a number of studies suggesting that ketosis was an effective weight loss mechanism. 75 In ketosis, the body switches its main source of fuel from carbohydrates to fat. Burning ketones instead of glucose means that the body burns stored fat. Atkins was not the first author to recommend a low-carbohydrate diet – in Dr Atkins’ Diet Revolution he recognised the first documented promoter of such a diet, William Banting, 76 a nineteenth-century funeral director in London, who had successfully adopted a high-protein diet to lose weight. 77 Atkins was also not the first to condemn carbohydrates in the twentieth century, as Gayelord Hauser, Adelle Davis and others had forbidden the use of white sugar, white flour and ‘devitalised’ industrial food. 78 Other books recommended similar restraints on the consumption of carbohydrates, such as Vilhjalmur Stefansson's Not By Bread Alone: Eating Meat and Fat for Stay Lean and Healthy (1946), Richard Mackarness's Eat Fat and Grow Slim (1958), Herman Taller's Calories Don’t Count (1961), and Robert Cameron's The Drinking Man’s Diet (1964). 79
Atkins's popularity can be explained in a number of ways. He was an ambitious Cornell-educated cardiologist, who wanted to spend time with patients rather than deal with hospital administrators. Determination and focus were qualities that Atkins showed from the beginning of his career; he chose the path less travelled by his peers, working as a freelance physician, covering night shifts, opening his own practice and becoming a physician and diet advisor to celebrities. Celebrity endorsement played a fundamental role in popularising his diet, as stars such as Jennifer Aniston, Renée Zellweger and Catherine Zeta Jones began to follow and publicise his diet. Although he did not conduct clinical studies himself, he used the success stories of the AT&T executives to bolster his claims. Lisa Rogak argues that another reason for Atkins's popularity was that he had a reputation for being ‘a ladies’ man’, allegedly having relationships with female patients and nurses working at his practice. 80 Rogak suggests that many women began to visit his practice just to meet Atkins, who was well dressed, handsome and spoke with confidence and authority. 81 Men also became interested in the Atkins diet because it spoke to dominant cultural tropes of masculinity: ‘The best part was that these men who so prided themselves on their masculinity – some were veterans of World War II – could eat beef and still lose weight without being hungry.’ 82 Atkins's diet presented men with the opportunity to display and perform their masculinity and achieve weight loss. With an Ivy League medical education, Atkins's authority was not questioned by AT&T personnel at the beginning of his career or by dieters later on. Atkins's authoritative voice and strict mannerisms – in person and through his books – led to him being regarded by dieters as a father figure, a role that Atkins often exploited by bullying them when they cheated on their diets. 83
Atkins wrote in an exaggerated and sometimes aggressive manner. In his attempt to demonise carbohydrates, he often resorted to unbalanced and extreme positions. Indeed, hyperbole was a pivotal element of Atkins's style, evident in an episode recounted by Rogak: Atkins once told a boy that the sugar in his sweets was dangerous, and the boy then asked: ‘What's wrong with sugar?’; Atkins replied: ‘Nothing, as long as you don't swallow it.’ 84 Like an evangelist, he used vivid language and imagery, referring to ‘carbohydrate poisoning’ or ‘no carbohydrates also means no hunger!’ 85 Atkins was radical in his views as he believed that modern diets were imbalanced due to their high carbohydrate and sugar content. He opposed previous dieting rules – as he stated that eating more resulted in losing weight – and subsequently opposed orthodox Western medicine by opening the Atkins Center for Complementary Medicine. 86
Another feature of Atkins's success was the controversy he attracted from mainstream medicine. Like Gayelord Hauser, Atkins's ideas were opposed by the AMA and the Medical Society of the County of New York. Atkins countered such opposition to his work by pointing out that, although the AMA had supposedly rejected his claims, one of his studies had in fact been published in the Journal of the American Medical Association. He also had feuds with other diet authors such as Nathan Pritikin, which generated further publicity and media exposure. 87 A keen opportunist and entrepreneurial maverick, Atkins accepted Oscar Dystel's book offer from the Bantam publishing house, with a signing bonus of $30,000. 88
Luck was on Atkins's side. Dystel was struggling to make Bantam Books profitable again and was willing to take big risks; Dr Atkins’ Diet Revolution was one of them. 89 Bantam Books hired a ghost writer, Ruth West, to help Atkins write the book plainly and without footnotes or a bibliography. 90 Although Atkins was sceptical initially, the publisher convinced him that the book was intended for a lay audience rather than the scientific community. 91 His books proved immensely successful; together, they sold more than 45 million copies worldwide, and 1,054,196 copies in the UK. 92 According to the British Broadcasting Corporation (BBC), in 2003 there were 3 million people in the UK following the diet. To this day, Dr Atkins’ Diet Revolution is the fifty-seventh bestselling book of all time in the UK, and until 2004 it was the bestselling book in the category Fitness & Diet, later replaced by Gillian McKeith's You Are What You Eat: The Plan That Will Change Your Life. 93
Through self-promotion, their perceived status and their ‘anti-establishment’ rhetoric, all of these self-help authors promoted individual agency in the pursuit of health and slimness. Readers, they all agreed, should take responsibility for their own health and for ensuring that they followed balanced, health-promoting diet and exercise regimes. By empowering citizens to make healthier choices to enable them to live more balanced lives, maintaining or restoring health became a responsibility – but also a possibility – for individuals as well as a benefit to the state in terms of reducing the healthcare burden and increasing industrial productivity.
Human agency and technologies of the self
Drawing on Anthony Giddens's assertions on the nature of the self in modernity, David Bell and Joanne Hollows argue that ‘self-help books offer advice on how to construct the self, but also contribute to changing ideas about the self’. 94 For example, self-help books on food and diet emphasise that readers possess not only the power to manage their own health, but also a moral obligation to do so. 95 This rhetoric stemmed from different cultural and societal ideals that emerged during the twentieth century. Notions of agency, for example, can be seen in the context of deepening commitments to neo-liberal theories of political economy, which as David Harvey has suggested propose that ‘human well-being can be best advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterized by strong property rights, free markets, and free trade’. 96 The neo-liberal state distanced itself from many responsibilities by placing the onus for maintaining health on individuals and the market. John Coveney has explored certain aspects of governmentality and its impact on food consumption, in particular in relation to Foucault's discussion of what he referred to as technologies of the self: ‘the way in which individuals internalise modes and rules of behaviour, emotion and thought in their everyday lives’. 97 Food and eating constitute one category in which individuals make sense of their surroundings, emotions and selves, and these diet books gave advice that resonated with contemporary technologies of the self.
By offering readers a way of preventing or treating modern illnesses, self-help authors promised readers hope. Many of the authors had themselves struggled with weight problems in the past, such as Robert Atkins, who lost twenty-eight pounds on his diet, and Dr Berger, who claimed that he had once weighed 420 pounds. 98 Testimonials from patients were also mobilised to emphasise the value of restoring agency. Atkins used them extensively in his book to complement his own success story. One patient history, for example, recounted how he had ‘lost that 90 pound without hunger and without cravings’, by eating one and a half pounds of meat and salads. 99 At the turn of the twenty-first century, Dr Andrew Weil responded to letters that he received, reminding correspondents that they had the power to change:
And this from Shelley Griffith of Massena, New York: I was on a program of my own due to the tragic (suicide) death of my twenty-year-old son, which took my health down the tubes. Then I ran across your book when I was searching for advice to bring my physical body back to good alignment … Your consciousness-raising methods are so ahead of Western, sterile, nonspiritual methodology, anyone with any sense of the greater picture will take heed. … I brought flowers indoors, did away with all vegetable oils, brought in extra-virgin olive oil, worked with garlic … And I went to the health food store for organic flours, grains, and beans. I decreased animal protein and bought green tea. I take echinacea and practice ‘news fasts.’ My personal development has been super, with renewed energy. The deep breathing has almost eliminated the grief, pain, and anxiety. Depression has lessened considerably, my weight has dropped, my chest pain has disappeared, and my circulatory system is back in balance. I also take some of the tonics you recommend, especially ginger and dong quai. I'm learning all I can. 100
Weil's message was clear: by taking simple steps such as changing elements of the diet, practising deep breathing or buying health foods, it was possible to achieve good health. By providing stories of ‘everyday’ and ‘ordinary’ individuals, the authors implied that their advice could be followed by anyone, a strategy that was reinforced by numerical evidence of success. For example, Stuart Berger used figures from 3,000 patients who had consulted him and lost a total of thirty-seven tons of fat between them. 101
Cultural reverence for rational truth, revealed by experts, was exploited by self-help authors, who demystified the process of losing fat at the same time as reinforcing belief in science. Distaste towards body fat, or lipophobia, was increasingly evident through the twentieth century, leading to moral panics triggered by the perceived threat of obesity to societal values and interests. 102 Controlled, healthy eating offered a route to social, as well as personal, change: dieting could bring secular salvation in the form of health, fitness and youthfulness. Dietary advice literature offered a rational means of conforming to body ideals through individual agency. Evidence for this comes from Dr Berger's Immune Power Diet, which was a bestseller in the 1980s. Berger took a direct approach to invoke a sense of responsibility in his readers. Berger's first section in the first chapter, ‘The immune power diet commitment’, urged readers to take their fate into their own hands, to move away from passivity towards actively pursuing better health. 103
Self-help books also promoted the ‘best’ diets and lifestyles for what each author considered the most balanced or ‘optimum’ health, energy and productivity. For example, Dr Berger wrote: ‘CONGRATULATIONS! Why? Because you have decided to become a healthier, happier more vital person.’ 104 Similarly, Gayelord Hauser's first page states: ‘A new theory on the treatment and prevention of a wide variety of ailments – the common cold, hay-fever, arthritis, high blood-pressure, chronic fatigue, overweight and many others – and holds out a promise of zestful good health for young and old.’ 105 This reflects a wider cultural phenomenon, the preoccupation of the Western world with efficiency, with generating healthy producers and consumers who actively pursued and achieved their own health, productivity, longevity, energy and happiness. John Coveney has referred to this as ‘the formation of a self-reflective, self-governing individual or collective subject’. 106 Adverts for various food brands also stressed agency, urging consumers to take care of their own health. As Alex Mold and Jane Hand show in Chapters 3 and 4, British advertisers and the Ministry of Food both reinforced this notion of agency through the middle decades of the century.
The moral responsibility and obligation that citizens had for maintaining their own health were often expressed in militaristic terms and linked explicitly to collective social interests. For example, Robert and Violet Plimmer argued that food was ‘the first line of defence against disease and in wartime against the enemy’. 107 A woman's obligation to provide ‘good nutrition’ for her husband and children was addressed often in Food Values. By discussing the effects of malnutrition on men, especially their physical unsuitability for joining the army, and the impact of improper nutrition on schoolchildren, the Plimmers stressed that women could serve their country by providing proper nutrition at home. A prime example of the influence of biopolitics at that time was that the Plimmers emphasised the impact of improper nutrition on productivity by including facts provided by insurance companies: 30,000,000 weeks of productivity were lost in 1933 due to illnesses lasting from one to four days, costing approximately £300,000,000 per year. 108 Pauling, too, framed individual obligations to consume adequate amounts of vitamin C in economic terms: ‘the damage done by the common cold to the people of the United States each year can be described roughly as corresponding to a monetary loss of fifteen billion dollars per year and in the United Kingdom to a loss of seven hundred million pounds per year’. 109 In addition, according to Pauling parents were obliged to give vitamin C to their children, because the vitamin had been shown to produce higher IQ scores. 110 Other self-help authors similarly discussed the benefits of their diets in terms of productivity, memory, concentration, feeling positive about oneself and leading long, healthy, active and productive lives. The line between self-help and societal help was blurred in these writings: healthier, more productive and longer-living individuals made society more productive and efficient.
Some readers expressed concerns about the hunger that attended dieting. Deborah Lupton has argued that in modern societies hunger is not just a physiological response to the absence of food. 111 Cravings and hunger were thought to be irrational and burdensome, especially to people with extra weight; in particular, they represented a lack of will that readers could overcome through rational self-control. Self-help authors assured readers that they would not experience ‘negative’ emotions such as hunger if they followed their eating programmes. Robert Haas, for example, tackled the issue of hunger by recommending that his readers could eat unlimited raw or steamed vegetables with their meals, and if they were active individuals that they should eat six times per day. 112 To fight cravings Haas instructed his readers: ‘There is no point in worrying about cheating occasionally. Enjoying a variety of foods is one of the luxuries of eating to win, as long as you stick to the Peak Performance Programme in the long run.’ 113
Berger also addressed the issue of deprivation by stating that his diet restored people to a ‘state of homeostasis, which eliminates nutritional spikes and drops, removes cravings and stops binges’. 114 Self-help authors thus mobilised dominant notions of balance and constancy evident also in popular and scientific accounts of stress that ‘emerged from the traditional matrix of modernity and its preoccupation with stability’, 115 which, as Jackson argues, constituted ‘the apotheosis of the modern urge to impose order and control on natural, social, and cultural systems’. 116 Balance also figured in other ways. According to the Plimmers, the ‘satisfactory supply of vitamins is a question of the proper balance of the whole diet … How much vitamin A is required daily? … A diet that is well balanced and contains a proper supply of the other vitamins will provide from 4.000 to 6.000 units’. 117 Berger similarly used concepts of balance and imbalance:
THE FIRST STEP – CORRECTING IMMUNE IMBALANCE … Sometimes an immune imbalance makes our immune cells attack healthy parts of our bodies in what is called an autoimmune response … Zinc is perhaps the most vital immune mineral. Without enough zinc in our bodies, many of the lymph system tissues actually shrink, including the thymus where crucial T cells develop. 118
Notions of balance were routinely accepted, but each author drew different conclusions as to what constituted a balanced state. Robert Haas, for example, rejected what mainstream science and medicine referred to as a balanced diet:
Forget the ‘Balanced Diet’. For years, nutritionists have recommended a balanced diet built from the four food groups for people concerned with physical fitness. Yet this kind of diet is actually very unbalanced. It contains too much protein and fat and too little carbohydrate. The only way to reach your level of peak performance, is by radically changing the amounts of protein, fat and carbohydrate in your meals and snacks. 119
Self-help authors had to find ways to cope with what Belasco has referred to as a cultural ‘antipathy towards “healthy” foods’, which in itself was another obstacle to individual agency. 120 The palate's aversion to ‘healthy foods’ could be catastrophic to diets; broccoli and Brussel sprouts did not look as appetising as burgers, pizza and ice cream, at least for most people. Self-help books had to portray eating healthily as an easy process that involved appetising and filling food in order to provide a viable alternative to the variety and superior taste offered by unhealthy foods. For instance, Atkins's diet offered people a way to lose weight on: ‘bacon and eggs for breakfast, on heavy cream in their coffee, on mayonnaise on their salads, butter sauce on their lobster; on spareribs, roast duck, on pastrami; on my special cheesecake for dessert’. 121
Self-help books exemplify how health was increasingly marketed as a commodity. Readers’ control over their own bodies depended on following advice given by self-help authors, but also on purchasing specific foods, drinks and supplements. The promotion of such goods included reference to the fact that they were inexpensive, easy to obtain and painless to ingest, as well as healthy in so many ways. According to Plimmer, ‘headache, constipation, anaemia, dyspepsia, nervous debility, wasting, obesity, lung weakness and kidney trouble … were all signs of malnutrition’, implying that purchasing and eating ‘healthy’ foods enabled readers to nourish their bodies to a state of perfect health. 122 The message here was clear: readers were no longer helpless, but lived in an age of affordable wonders in which they could combat not only malnutrition, but almost every condition imaginable, through buying ‘health’ foods and products. This is evident in the way Linus Pauling urged his readers to have a life without colds by buying vitamin C supplements. He firstly argued that the common cold caused unnecessary suffering and resulted in a loss of productivity and income. 123 Having offered advice on how to prevent and ameliorate a cold, Pauling then compared vitamin C with other over-the-counter medicines and antibiotics. Vitamin C, he argued, offered the easiest, cheapest and most efficient choice with fewer side effects, making health foods and supplements desirable commodities that readers could purchase and ingest for their own health's sake. ‘By the proper intakes of vitamins and other nutrients’, Pauling argued, ‘and by following other healthful practices from youth or middle age on, you can, I believe, extend your life and years of well-being by twenty-five or even thirty-five years.’ 124
Although they shared some characteristics, self-help authors each possessed their own notions of balance, distinct dietary and lifestyle philosophies and writing styles. Each of these authors exploited their language, tone and expressions and used metaphors and similes to explain and encourage dietary change. Gayelord Hauser, for example, stated: ‘You are holding a passport to a new way of living … You are beginning a new adventure, a journey of discovery.’ 125 His advice offered a reinterpretation of the cosmos, or what the anthropologist Anthony Wallace referred to as a ‘mazeway resynthesis’. 126 Salvation was promised through adherence to new worldviews: youth and longevity lay purely in the hands of the individual. In addition to balanced diets, Hauser also recommended that readers manage or regulate their emotions and thoughts, and emphasised the need for balanced reciprocity in marriage; in later years, he argued, marriage should revolve around ‘mutual interests, mutual accomplishments, as well as mutual affection’. Atkins adopted an alternative approach to Hauser's, capitalising sentences in order to urge readers to join his ‘revolution’: ‘A REVOLUTION IN OUR DIET THINKING IS LONG OVERDUE’; and ‘WE ARE THE VICTIMS OF CARBOHYDRATE POISONING’. 127 These books were motivational, inspiring and easy to read; their conversational style made them appear more accessible and their goals more achievable.
Personal agency was also reinforced by stressing the fact that readers themselves could improve their own health without doctors, expensive and invasive treatments, or pills. In Folk Medicine, for example, D. C. Jarvis promoted the different uses of apple cider, honey and kelp for the prevention or treatment of a plethora of health conditions such as chronic fatigue, headaches, high blood pressure, sleep disorders and infertility. 128 Pauling's belief in the efficacy of self-care can be seen in his advice that, by not seeing ‘the “doctor as God”, you can avoid serious errors in your own care’. 129 Pauling also challenged the medical establishment and pharmaceutical industry as he compared vitamin C supplements favourably to commercial remedies such as aspirin and phenylpropopanolamine hydrochloride. 130 In Life Extension, Durk Pearson and Sandy Shaw promoted consumer choice as a route to better health and questioned the guidelines set by the Food and Drug Agency's (FDA) recommended daily allowances (RDA) of vitamins and minerals. 131
Self-help authors echoed the views of clinicians – discussed by Martin Moore in Chapter 2 – that the health of diabetics depended to an extent on their own intelligence and reliability. Knowledge, agency and ‘intelligence’ had to be taught to diabetic patients and similarly to self-help readers. For example, being healthy was not a difficult endeavour, as Plimmer stressed that ‘the ordinary person can plan his or her daily food without elaborate calculations’. 132 More flatteringly, Hauser's readers were reminded that simply by choosing to read his book they had taken a smart decision to live longer and feel younger. Hauser offered his readers a way to eat ‘intelligently’; his books would enable people to expand their knowledge of foods, vitamins and minerals, as well as learning other holistic methods to maintain their youth. 133 A similar message was conveyed by Pauling and by Pearson and Shaw, who presented all the available information about vitamin C and antioxidants respectively, allowing readers to evaluate and criticise the recommendations of orthodox medicine and the FDA. Atkins went further, offering his readers a way to monitor their weight loss through the self-application of scientific methods. He urged his readers to purchase a home urine chemistry kit, Ketostix, which they could use to track whether or not, or to what extent, they were in ketosis. 134 ‘Happiness is a purple stick’ Atkins used to say, referring to the Ketostix, which constituted a physical manifestation of successful self-care. Pearson and Shaw also wanted readers to perceive themselves as scientists, as they dedicated a whole chapter to life-extending experiments in the home such as the cooking oil shelf-life test and vitamin C urine test using C-stix. 135 Robert Haas taught readers about high-density and low-density lipoproteins, blood glucose levels, triglycerides and uric acid. 136 The significance of these scientific endeavours lay in the fact that readers actively sought ways to measure, quantify and evaluate their own health, which reinforced a sense of control and mastery over their own bodies and allowed them to achieve a healthy state of physiological and psychological balance.
This chapter has considered some of the most popular self-help books in the genre of diet and health in order to understand more clearly how self-promotion, self-help, individual agency and personal responsibility for health came to dominate advice literature in the second half of the twentieth century. The authors of self-help books promoted self-care firstly through reference to their scientific expertise and scientific evidence. Self-help authors, who were almost exclusively men, published routinely on popular platforms instead of scientific, peer-reviewed journals, which made them appear to their readers as pioneers and revolutionaries.
All of the books explored in this chapter emphasised that readers could and should take care of their own bodies and safeguard their own health. The narratives were replete with notions of balance and neo-romanticism, and reflected interest in constructing new forms of selfhood through consumption and healthy lifestyles. The inclusion of insurance-related statistical figures by Plimmer and Pauling suggests that Western societies embraced and internalised a form of self-reflective, self-governing individualism, as well as the notion of efficiency, which most authors dealt with, if sometimes remotely. While Plimmer emphasised the impact of malnutrition on productivity and the strength of armies, Hauser promoted a graceful, youthful and productive old age, and Atkins offered people an escape from the carbohydrate poisoning, hunger pangs and mood swings that caused illness and loss of productivity.
The cultural capital of rationality and knowledge, a legacy of Enlightenment ideology, is also evident in these books as authors portrayed themselves as visionaries in the field of dietetics, supplementation and health. They emphasised how rationality, education and intelligence could lead to better health; facilitated the use of charts and graphs; recommended exact quantities and foods; and encouraged readers to undergo specific tests and to purchase supplements. Health, according to these authors, was observable, quantifiable and measurable, and they wrote in a way that made clear to their readers that good health was the product of the victory of mind over body, of rationality over primitivism. As Parasecoli has argued, through the promotion of specific foods, drinks, supplements, stores, products, tests and practices, these authors contributed to the commodification of health. 137 Readers could relatively affordably – but with sufficient willpower – improve their own health. According to self-help authors, rejection of the cultural authority of orthodox medicine and the adoption of more carefully balanced pathways to health constituted the most intelligent and rational form of self-care.