Five Little Peppers and How They Grew by Margaret Sidney is an early example from 1881. This book describes the daily life of the hardworking Pepper family and how they remain cheerful and loving despite challenges associated with 19^th century poverty. The Pepper family consists of widowed Mrs. Pepper or “Mamsie,” 11-year-old Ben who voluntarily takes on the mantle of “man of the house,” patient and selfless 10-year-old Polly, impulsive and food-loving 9-year-old Joel, gentle and conscientious 7-year-old Davie, and beloved baby of the family 3-year-old Phronsie.

Children’s literature during this era was heavily instructional and used relatable characters and stories to teach morals and values to young minds. Illness was rarely just a biological event; it was a test or demonstration of character. In a chapter aptly titled “Trouble for the Little Brown House,” the first challenge that the Pepper family faces is measles.

Notably, this book highlights the ophthalmologic symptoms and sequalae of measles, as first Phronsie, then Ben, Polly, and Joel all catch the infection. Common early symptoms of measles include conjunctivitis and photophobia, which occur before the obvious rash. Ben and Polly, the hardworking older siblings who earn money for the family by chopping wood and sewing respectively, are each in initial denial of infection because they understand the financial repercussions this will have on the family. But the historic reader understands the warning signs when Ben and Polly report visual complaints. Ben tries to reassure Polly by saying, “I’m all right; only my head aches, and my eyes feel funny,” alluding to the itchy and gritty sensation of conjunctivitis, before he becomes bedridden. The narrator describes Polly’s struggles more vividly, “An awful feeling made her clutch the back of a chair, but she managed somehow to get into her clothes, and go groping blindly into the kitchen. Somehow, Polly couldn’t see very well. She tried to set the table, but ‘twas no use.” Polly’s initial visual impairment can be attributed to severe photophobia, leading to blurry vision.

Modern day readers may not know that the measles virus can result in serious vision-threatening complications. It can cause deeper structural damage starting with keratitis – a painful inflammation or infection of the cornea, the clear front surface of the eye, which manifests as blurred vision and intense tearing. If keratitis is left untreated or a secondary bacterial infection occurs, corneal scarring can permanently impair vision. In rare instances, measles can also cause retinopathy and optic neuritis leading to blindness. The severity of eye damage from measles is heavily linked to nutrition. The virus actively depletes body stores of vitamin A. In low-income populations where vitamin A deficiency is already common, measles is more likely to cause permanent childhood blindness.

The Peppers live in poverty and hunger. Mrs. Pepper makes a meager income sewing “sacks and coats” for a local store and “had hard work to scrape together money enough to put bread into her children’s mouths, and to pay the rent of the little brown house.” There is never enough food to go around. Their main source of calories are coarse brown bread and unappetizing cornmeal mush, neither of which contain meaningful amounts of vitamin A. However, the generosity of the parson’s wife, Mrs. Henderson, helps protect some of the Peppers from blindness. Mrs. Henderson gives the Peppers “a little pat of butter,” which Phronsie and Ben put on their bread. Dairy, like milk and butter, is an excellent source of vitamin A. And later, Mrs. Henderson sends over “a little bird delicately roasted,” which Joel consumes with delight. Poultry and gamebirds are another good source of vitamin A.

However, selfless Polly saves the butter and bird for her siblings and ends up being most at risk for permanent vision loss. She develops very painful eyes, suggesting keratitis, and the doctor pronounces that “her eyes are very bad” and warns, “You will be blind!” if she doesn’t take care. Although the author attributes Polly’s illness severity to eye strain from sewing to earn money for the family, it is medically more likely due to vitamin deficiency. The therapeutic value of vitamin A in treating measles was not discovered until 1932 – 51 years after the publication of this book – when British physician Joseph B. Ellison found that administering vitamin A extracts roughly halved the death rate of hospitalized children suffering from measles [1]. Studies establishing the role of vitamin A in reducing blindness in children with measles did not occur until the 1980s [2,3].

Because moralizing 19^th century children’s literature rewards the virtuous, Polly ultimately makes a full recovery. However, reality is not so kind. Even today in the 21^st century, an estimated 15,000 to 60,000 children are blinded by measles every year globally [4]. The World Health Organization recommends that children in low income and developing regions diagnosed with measles receive immediate, high-dose oral vitamin A [5]. This simple, low-cost intervention protects the cornea and has successfully saved the eyesight of millions of infected children [6]. And, those who are vaccinated against measles are spared the risk and need for intervention completely.

[1] https://pubmed.ncbi.nlm.nih.gov/20777111/
[2] https://pubmed.ncbi.nlm.nih.gov/8486934/
[3] https://pubmed.ncbi.nlm.nih.gov/3492298/
[4] https://pubmed.ncbi.nlm.nih.gov/14998696/
[5] https://www.who.int/news-room/fact-sheets/detail/measles
[6] https://pubmed.ncbi.nlm.nih.gov/24407830/

Original Publication: The story was originally serialized in an 1880 edition of Wide Awake, a children’s magazine and later published in a hard cover edition.

Dover Publications, 2006. 224 pages

Web image by Medhum.org

The Sick Child

The sick child is thought to be the artist’s sister. She is not a child but rather a young girl who is lying down or seated, with a blanket over her lower body and she faces a woman who is seated beside her, clutching the child’s left hand. We cannot see the woman’s face – it is turned down as she is bent over in apparent grief. While the painting’s title names the girl as the subject of the painting, it is the grieving woman and her attention to the girl that is particularly striking.

Death and the Child

Death and the Child depicts the anguish of a child who has been confronted with the corpse of her mother lying in bed. The child faces the viewer, hands pressing against her ears – she cannot bear to “hear”/ absorb what she has encountered; her face has an expression of fear and despair

Death in the Sickroom

In Death in the Sickroom several adults are scattered about, some standing, one woman sitting in the foreground; behind her another woman stands facing us. In the back of the room a figure sits on a chair, a blanket draped over her lap – presumably this is Munch’s sister. With his back to the wall an elderly man has both hands pressed to his chest. These individuals have come to help and mourn but they are isolated from each other, which adds to the grimness of the scene.

Image credits: wiki commons

Painting with Empathy: The Expressionist Art of Edvard Munch with Curator Øystein Ustvedt

Russell Teagarden 12.28.23 1857

Edvard Munch’s emotional portrayal of illness and suffering offers profound insights for health professionals and…

At age nine, first misdiagnosed and finally identified as having facial bone cancer (Ewing’s sarcoma), Lucy underwent several surgeries and more than two years of intensive chemotherapy and radiation treatments. Pain and nausea, anxiety and fear of more pain and nausea were only part of the ordeal. The young Lucy became aware of what it is to be severely, chronically ill. Her sisters behaved differently toward her: they were polite. “Suddenly I understood the term visiting. I was in one place, they were in another, and they were only pausing.” Even her father felt uncomfortable at her hospital bedside, and Lucy was relieved that he came infrequently.

But being at home was worse: in the hospital the other patients and the staff expected little from her and she felt no guilt or shame; amidst her family, she blamed herself for the tension, arguments over money, and her mother’s depression, even though these elements had existed prior to her illness. Her hair fell out and she became dimly aware that people were staring at her face. Nevertheless, “I . . . was naturally adept at protecting myself from the hurt of their insults and felt a vague superiority . . . . “

Well enough to return to school, Lucy’s disfigured face drew taunts from classmates; she understood finally that she was perceived as ugly and that she would not be loved. Only on Halloween, when she could mask her face, did she feel free and joyful, unconcerned about her appearance, “normal.” Her moods now alternated between despair, determination, and escapism. She became convinced that only facial reconstruction and a restored appearance would make life bearable.

During years of reconstructive surgery Lucy evolved complex rationalizations to give meaning to her suffering. Two anchors had stabilized her existence throughout the misery: a passionate adolescent love of horses, and an adult love of poetry. Eventually outward appearance and inner life became harmonious. “The journey back to my face was a long one.”

Unfortunately, Lucy’s story does not end here. At age 39 she committed suicide. Soon after, her close friend, writer Ann Patchett, wrote a book about their friendship, Truth & Beauty: A Friendship, published in 2003 (HarperPerennial).

Lucy Grealy Interview in 1994 (20 Min.)

Autobiography of a Face
Lucy Grealy
Houghton Mifflin 1994 Boston: 256 pages

1995 Whiting Award Winner in Nonfiction , Poetry: https://www.whiting.org/awards/winners/lucy-grealy
Web image generated from the book cover by Medhum.

There is nothing to read on the psych unit but a bulletin board listing the daily activities and some magazines. This makes Chihaya think about her relationship to books, which is a complex one. She muses that “it is every writer’s fear that our books will be the death of us” (p. 11) and humorously writes about how she once had a bookshelf that was so wobbly she worried it would topple over on her. However, the real damage that books inflict may be insidious. The author first began to read as an escape from her unhappy childhood, but she fears she now “love[s] books to a dangerous degree” (p. 20).  They have become her life to the extent that she does not know if she “would be anyone at all” (p.12) without them. A feature of her depression is that she has completely lost interest in reading. She half-seriously coins the diagnosis “bibliophobia” to describe her condition. It will take just the right book to cure her, and when she finds it, she begins to read again, and to heal.  

Over the course of Bibliophobia Chihaya tells us about the books that have been of vital importance to her, many of which she associates with relationships or with stages in her life. Eventually, she reads the DSM about her own psychiatric diagnosis, and she reads books that other people have written about their depression. Working with a therapist, she realizes she needs to move on, and she lets go of her academic career. By the end of Bibliophobia we learn that Chihaya has finally written a book, but it is not the one she was expecting to write. It is Bibliophobia.

Bibliophobia is an unusual hybrid of a book that is part literary criticism part memoir. The author has been influenced by numerous mental health memoirs including recent celebrated works by Donald Antrim, Esmé Weijun Wang, and George Scialabba.

The first chapter, the subsequent emotional journey of the author, and her conclusions all captured my attention. I must confess that much of the rest of this book interested me less for the simple reason that I had not read any of the books the author discusses in detail. I do not even think we have the same taste in literature. However, this may not prove to be a stumbling block to potential readers who are fans of Toni Morrison, Anne Carson or Anne of Green Gables, or who just love reading about books.

According to the American Psychiatric Association, stigma around mental health is common in Asian American communities. One praiseworthy attribute of Bibliophilia is how it calls attention to the challenges that these groups experience in accessing care. Chihaya, was raised by a Japanese father and a Japanese Canadian mother who “did not believe in the concept of mental health; everyone was either fine or just complaining” (p. 49). Growing up with the message that depression is “not for the children of immigrants [but] something that happen[s] to white people in independent films” (p. 7) it goes without saying that Chihaya cannot bring her symptoms to her parents’ attention. Filled with shame, it takes her many years until she can no longer ignore them. Fortunately, Chihaya has given us a book filled with insights that one hopes will inspire others to seek help.

Bibliophobia
Sarah Chihaya
Random House, New York, 2025, 214 pages

References:
https://www.psychiatry.org/psychiatrists/diversity/education/asian-american-patients
Web image from Wikicommons.

These changes have not all been for the better. Perhaps you have noticed such unsettling changes yourself. A child in a restaurant is glued to a tablet screen, probably the last resort of a weary parent trying to enjoy their first peaceful meal in days. A group of tourists in Paris marvels at the Eiffel Tower, not as it is, but as it appears through their phone camera and on their phone screen. Neighborhoods have become quieter and less lively, as children have retreated from the streets and hunkered down at home with their phones. 

Jonathan Haidt, a social psychologist at the NYU Stern School of Business, elaborates upon these ideas in his book The Anxious Generation. In this book, he describes the dual trends of increasing smartphone/screen-based engagement, driven by perverse economic incentives of technology companies, and decreasing real-world, human-to-human play, driven by over-protection from modern parents. The collision of these forces has defined Gen Z, born between 1997 and 2012, as the most anxious and depressed generation of our time. 

In the book, Haidt notes that the tactics of technology companies to drive increased user engagement have been well documented by activists such as Tristan Harris. Much like tobacco companies in the mid to late 20^th century, modern technology companies prey on young users (e.g. children) as a source of future/recurring revenue, and fight off consumer protections through aggressive lobbying campaigns at the government level. As a result, children are spending record numbers of hours on smartphones, increasingly isolated from the real world and irritable when deprived of their digital drugs. Haidt also observes that the technology problems of girls and boys are unique. For example, girls are significantly more prone to social media addiction and the associated psychological disturbances such as distorted body image and self-worth. On the other hand, boys are much more avid users of video games and pornography, which reduce their desire for real-world play and romantic relationships. 

Haidt also notes that over a longer but overlapping time period, children have been overly protected from real-world responsibilities and real-world play. He attributes these new attitudes to the changing media landscape and how crimes are portrayed in the news, as well as legal challenges which have incentivized parental overprotection. In one example, he describes a pitiful incident in which an eight-year-old child was seen walking the streets alone, and a concerned passerby called the police to report an “abandoned child.” In this case and many others, parents have been held responsible for this absurd new “crime”, a sight which would have been entirely commonplace 30 years ago. Haidt highlights the irony of how the real-world, full of rich experiences, appropriate risk-taking, and character-building responsibilities has been overly regulated by our society, whereas the digital world, rife with dangers for growing adolescent minds, has been almost entirely unchecked, unregulated, and ignored.  

Bringing people out of the digital world and into the real world is a formidable task. One strategy that Haidt found success with was to encourage people to reconnect with a sense of awe in the world. Awe is a vague concept, but can be defined as a feeling of wonder inspired by the sacred or sublime. The real world is full of such awe-inspiring moments, if only we could stop to notice them. In a comically simple exercise, Haidt encouraged students in his university course to take a walk through Manhattan without their phones or headphones, and then to write about their experience on this “awe walk.” The written reflections were so beautiful that he included excerpts of his students’ work in the book to illustrate how such simple measures could have such a profound impact. One such excerpt is reproduced below: 

For children who have no choice but to grow up in the digital era, Haidt attempts to boil his recommendations down into four rules for a healthier childhood:  

1. No smartphones until high school. 

2. No social media before the age of 16. 

3. No phones in schools. 

4. More independence, play, and responsibility in the real world. 

He recognizes that while these solutions are simple, their implementation is anything but. As a society, we face a daunting collective action problem as it pertains to technology and real-world experiences. Such problems require collective solutions, and Haidt encourages parents to get together, organize, and raise their children together in a real-world oriented manner. While broader changes in school policy may seem out of reach, Haidt encourages struggling schools to get inspired by the numerous case studies of schools that went phone-free and experienced positive changes by almost every metric, within a matter of two to three years. 

Some may say that our society is too far gone to reverse these negative changes, but this is certainly not the case. In fact, people are more skeptical now than ever of the negative role of technology in our lives, and collective action on this problem may be easier now than it ever has been before. As we sit perched on the precipice of a new technological revolution in artificial intelligence, this sentiment has already garnered potent opposition to unchecked technological advance and implementation. Will we learn from our past mistakes? Unfortunately, our track record is not encouraging. Only time will tell how far we go before we decide we need a detox. 

The Anxious Generation 
Jonathan Haidt 
Penguin Press, New York City, March 26, 2024, 400 pages
Web Photo by Joel Fulgencio