If there was ever an ironic title for a book about the best ways of achieving a long and healthy life, it’s this one: Eat Your Ice Cream. That’s because a major conceit of the book is that if we are to incorporate all the recommendations for achieving good health into our lives, some balance—tradeoffs—will be necessary. Eating ice cream exemplifies that balance: when consumed in moderate amounts, it offers some nutrients and a lot of happiness.  

The author, Dr. Ezekiel Emanuel, known to all in his many circles by the mononym “Zeke” (think: Sting, Prince, Oprah), points to a couple of motivations for writing the book. One is in the service of his life-long quest to “improve Americans’ health.” (p. 11) He has gone about this in many ways including his service as a medical oncologist, chief of the National Institutes of Health Bioethics department, medical school professor, health policy researcher, author of many books and articles on a range of health care subjects, and as an architect of the Affordable Care Act (aka, “Obamacare”). His other motivation arises from his view that current wellness advice makes it “nearly impossible to differentiate the valid, reliable, and effective from the speculative, deceptive and just plain stupid.” (p. 4). His aim, then, is to “provide a concise, clear, and authoritative synopsis of what health experts know works best to bring the biggest health benefits—without extraneous, speculative, or absurd additions.” (p. 11) 

Getting a Six Pack 

Running through the book is Zeke’s insistence that wellness behaviors and practices will be most effective when they become part of daily life and not something separate or extracurricular, and as such wellness rules “become an invisible part of lifestyle, sustained by habit.” (p. 10) He gives himself the task of cutting through the jungle of wellness advice and providing “a distillation of the evidence to simplify doing the right thing” for a healthy life. (p. 9) 

In keeping with his theme of simplicity, he breaks down wellness advice into “the six wellness behaviors that yield the maximum benefits with the least work.” (p. 9) They are: 1) avoid self-destructive behavior; 2) cultivate family, friends, and other social relations; 3) stay mentally healthy; 4) consume healthy food and drink; 5) exercise well and regularly; and 6) get the rest you need. He hastens to add that these six behavior categories reflect the thinking of ancient times among Greeks, Chinese, and Indians.  

Each of the wellness behavior categories constitutes individual chapters. In each, Zeke covers both obstacles to attaining good health (e.g., heavy alcohol consumption) and practices that facilitate attaining good health (e.g., getting vaccinated). His recommendations are based on evidence from credible sources and are time tested. He presents them in more of a conversational form in plain language and not much in the way of strict protocols or mechanical algorithms.  

While Zeke considers all six wellness behavior categories crucial to a healthy and long life, he does not rank them in importance or priority. He does, however, form two groups from them and makes a distinction between the two, noting that “risk management, friendship and social interactions, and mental engagement have a measurably greater impact on your wellness than diet, exercise, and sleep.” (p. 8) This may come as a surprise to hardcore health advocates who put a major emphasis on, if not obsess about, exercise, diet, and sleep. Zeke goes further to say about the zealots: 

They ignore the importance of family, friends, and social relations—the emotional wellness behaviors—which have a remarkable impact on the quality and length of one’s life. And it’s a dangerous fallacy that a deficit of emotional wellness behaviors can be remedied with a surplus of physical wellness behaviors. No amount of kale or number of steps or hours of sleep can replace the importance of building and maintaining good relationships for wellness and longevity.  
(p. 54) 

He comes back repeatedly to the greater importance of social over physical components for good health. He seems a bit obsessed with it, though convincingly so.  

Neither Extremist nor Scold 

Distinguishing this book from others in the field is how Zeke does not scold people to abandon all behaviors that can work against achieving a healthy life, nor does he advocate people push themselves to extreme levels of compliance and sacrifice. Neither is sustainable and both can result in futility and abandonment. He urges us to find the mix of behaviors and levels of commitment that can be woven “into the fabric of your everyday life so they become automatic and easy, not a chore, burden, or all-consuming fixation. (p. 187) 

Zeke offers ways to moderate specific recommendations or to make trade-offs. One example is alcohol consumption. He realizes that although alcohol should be avoided, that’s not likely. When it can’t, he advises that people at least not drink alone because some of the risks of a daily drink “is probably outweighed by the benefits of time with friends.” (p. 34) As another example, Zeke advises that exercise is essential, but when excessive, diminishing returns can result. “Exercising 2 or 3 hours a day will not improve your longevity more than 45 minutes a day.” (p. 164) Furthermore, in this regard, he says, “There’s something to be said for living fully and being present, not constantly monitoring our activity tracker or feeling guilty for not achieving every wellness goal.” (p. 10) Don’t obsess, and toss the wearables.  

So, go ahead, eat your ice cream, but not too much, and do it with family and friends. Then walk home safely and get a good night’s sleep.  

Photo attributions: 

Hubert Opperman eating an ice cream next to a Peter’s Ice Cream Reo truck, 1936 
Sam Hood  
State Library of New South Wales collection, No restrictions, via Wikimedia Commons 

Melba Phillips Eating Ice Cream 
Emilio Segrè Visual Archives  
CC BY-SA 4.0, via Wikimedia Commons 

The phenomenon sometimes referred to as “baby blues,” a mild transient state affecting as many as 80% of new mothers, had been recognized early on. In his influential 1946 book on baby care Dr. Benjamin Spock advised that one could snap out of it by just going “to a movie, or to the beauty parlor, or [getting] yourself a new hat or dress” (p. 29). If a new dress did not do the trick, the implication in that era was that you were a defective woman. In the 1962 edition, Spock still repeated the same advice verbatim. The notion there could be a persistent mood disorder requiring treatment required far longer to catch on. In her book, Moran elucidates some of the factors that rendered it difficult to accept the existence of postpartum depression and explain why persistent advocacy was necessary.  

One such factor involved organized psychiatry. While early editions of the DSM (the Diagnostic and Statistical Manual of Mental Disorders) had proposed psychodynamic causes for mental illnesses, in an attempt to be neutral about their origins the DSM-III did not include postpartum disorders as discrete entities. One implication of this was that there was no code to use to get health insurance to reimburse for medical care. The result, according to James Alexander Hamilton, a psychiatrist who had written the first modern monograph on postpartum mental illness, was that “many thousands of very sick women [were] very badly treated” (p. 67). It took several editions of the DSM until this was addressed. And even in DSM-V, postpartum depression would still be coded as Major Depressive Disorder with peripartum onset.  

Eventually the idea there was something more serious than” baby blues” yet still relatively common took root in the public consciousness. One began to hear about it on television talk shows. Yet these appearances often featured extreme cases such as that of Andrea Yates who had drowned her five children: “Tragedy and insanity got ratings. This still allowed advocates a chance to raise awareness on a massive national platform. But it also made postpartum depression frightening and unclear” (p. 166). It took celebrities such as Brooke Shields to come out about their experiences to change the national conversation. After publishing a memoir about her postpartum depression, in 2005 the actress went on the Today Show where she was criticized by Tom Cruise for using antidepressants. When the public rallied behind Shields, this proved to be a turning point for the movement. 

When national bipartisan legislation was proposed to increase awareness and to fund research for postpartum depression, the issue became a political football. Anti-abortion activists coined a brand new “disorder” they called “post-abortion syndrome” and would not consider supporting one without the other. It was not until the passage of the Affordable Care Act that the MOTHERS act went through, and not even then without the concession to abortion politics.  

If Moran’s book breezes through the science behind postpartum depression somewhat rapidly, its chronicle of an important advocacy movement for women’s health makes it worthwhile, and its extensive use of oral histories within the context of the author’s own history ensures it is an interesting read.  

Blue
Rachel Louise Moran
University of Chicago Press, 2024, 304 pages

Web image by Alexander Grey 

See https://www.postpartum.net/ for information about Postpartum Support International, one of the advocacy groups profiled in Blue.