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Rich Cohen’s memoir “Sweet and Low” gets psoriasis wrong
The popular memoir "Sweet and Low" by Rich Cohen tells the story of Cohen’s grandfather, the inventor of the artificial sweetener Sweet’N Low, and of Cohen’s immediate family’s ultimate disinheritance from the extended family’s massive fortune.  In the telling of that fortune lost, Cohen pins blame on an aunt, who is described as being a recluse suffering with psoriasis and psoriatic arthritis. But perhaps in an effort to target his aunt, the book instead harms the as many as 7.5 million Americans with psoriasis and/or psoriatic arthritis by trivializing psoriasis and describing it inaccurately.
Psoriasis Cure Now wrote to the author in April 2006, and to the publisher, Farrar, Straus and Giroux in July 2006, asking them to correct the record in future editions of the book, starting with the paperback edition.
Click here to read our news release on the book. And read on for a detailed examination of the mistakes contained in the book’s discussion of psoriasis.
What Sweet and Low says, page x:
Jokingly refers to his aunt as “crazy” and writes: “Whenever I asked what was wrong with Aunt G., why she never left her room, words were muttered about arthritis, psoriasis, lack of confidence.”
Reality check:
Lack of confidence can certainly be a symptom of psoriasis, particularly in serious cases. More on that is discussed below.
What Sweet and Low says, pages 66-67:
“G. had in fact suffered an outbreak of psoriasis, a skin disease she developed in early adolescence. … In a healthy person, dead skin sheds every six or seven days. In a psoriatic, dead skin doesn’t slough off for months. Bacteria builds up, turning the skin red and scaly.”
Reality check:
This is backwards. Here’s the American Academy of Dermatology’s accurate description:
"Parakeratosis is a word you may have come across when you read about psoriasis, especially plaque-type psoriasis. It is a term that describes the process by which psoriatic skin continuously forms and scales off.
In normal skin, the outer layer, made up mostly of cells called keratinocytes, is replaced every 27 to 28 days with newly formed keratinocytes. …
In psoriasis, the process of keratinocyte production is sped up. New keratinocytes are formed and moved upward to the skin surface faster than they can be incorporated into skin. Some are moved upward so fast that they are not yet mature cells. The keratinocytes accumulate and are scaled off. Parakeratosis is the word used to describe the entire process.
Psoriatic plaque has other features also, including inflammatory cells and dilated small blood vessels that contribute to both the appearance and the symptoms of a psoriatic lesion.
In general, the cycle of psoriasis can best be described as the body's immune system triggering excessive skin-cell reproduction. In healthy skin, cells mature and are shed in about 28 days. In people with psoriasis, this process is accelerated to only 3 or 4 days."
This is why people with psoriasis often seemingly “shed” right before your eyes (and why some refer to themselves jokingly as “flakers”). While this error is not of practical consequence, it is an indication that perhaps this section of the book was not carefully researched.
What Sweet and Low says, page 67:
“In some instances (this is true of my aunt) the condition is accompanied by arthritis, which can deform hands and fingers. But even in the worst cases, the disease is simply not disabling. It is suffered instead as a chronic annoyance, with good days and bad days.” [emphasis added]
Reality check:
This is factually wrong, and is damaging to millions of Americans who battle with insurance companies, employers, government officials who disburse biomedical research funding, and others who do not understand the seriousness of psoriasis. This is even contradicted by a source cited later in the very same paragraph. In the book Essential Pathology, edited and partly written by Emanuel Rubin, the four co-authors of the section entitled “THE SKIN” write on page 646:
"The severity of the disorder varies from annoying, scaly lesions over the elbows to a serious, debilitating disorder involving most of the skin and often associated with arthritis."
Psoriasis, even in the absence of psoriatic arthritis, can be, and is for many Americans, debilitating. When joint and bone damage from psoriatic arthritis is added to the equation, psoriasis can be even worse (and in the 1950s and 1960s, when Cohen’s aunt was reportedly hit with a severe flare of these diseases, this was even more true, due to the lack of disease-slowing treatments that have only become available recently.
What Sweet and Low says, pages 67:
“In his book Essential Pathology, Emanuel Rubin writes, ‘By far the most disturbing aspect of psoriasis is its appearance. …’”
Reality check:
For many patients, it is certainly true that the visible nature of the disease is its most troubling aspect, although for those with severe disease, like the aunt’s case described in the book, the physical symptoms can be equally or more devastating. (Those unfamiliar with how moderate to severe psoriasis can appear should take our 60 Second Challenge.)
A National Institute of Mental Health-sponsored study in the Journal of the American Academy of Dermatology found that “Patients with psoriasis reported reduction in physical functioning and mental functioning comparable to that seen in cancer, arthritis, hypertension, heart disease, diabetes, and depression.”
What Sweet and Low says, pages 67:
“Specialists have spent careers trying to determine the causes of an outbreak. Most agree it’s in some part psychological. In The Encyclopedia of Family Health, Marshall Cavendish writes, ‘…studies indicate psoriasis may be an outward expression of subconscious problems.’”
Reality check:
This is pop psychology hogwash. It can’t be disproven, but it has never been proven, either. Remember: psoriasis is linked to several genes people are born with, and hundreds of thousands of children—and even some infants—have psoriasis. (Perhaps those infants with psoriasis are grappling psychologically with being mistreated by mom’s gallbladder while in utero.) While stress is generally believed to be a trigger for some psoriasis flares, there are numerous well-documented sources of flares. Consider again what the book Essential Pathology says, in a section not quoted in Sweet and Low:
“PSORIASIS …. Psoriasis unquestionably has a genetic component….
A variety of stimuli, such as physical injury, infection, certain drugs, and photosensitivity, may produce psoriatic lesions in apparently normal skin.” (page 646)
It is also worth mentioning that the “Marshall Cavendish” Rich Cohen quotes is not a man who wrote The Encyclopedia of Family Health. In fact, the Marshall Cavendish Corporation is a giant book publishing company that published that title. So when Cohen writes on page 67 that “In The Encyclopedia of Family Health, Marshall Cavendish writes,” it is like someone saying that Farrar, Straus and Giroux wrote Sweet and Low. Or for an example more appropriate, since Mr. Cohen is an editor at Rolling Stone magazine, it would be like someone saying “That Led Zeppelin is a great singer.” A trivial mistake, but again one that suggests poor research.
Incidentally, the guy who wrote that falsehood about psoriasis patients in The Encyclopedia of Family Health is a prolific pop-health writer named Robert Youngson. The School Library Journal writes of this book: “Grade 7 UP … Concepts are usually covered with adequate background information for beginners….” A junior high-level text is hardly a compelling source to use for such an offensive claim.
What Sweet and Low says, pages 67-68:
The book emphasizes the aunt’s lack of exercise as a cause of her poor condition.
Reality check:
This section of the book details the aunt’s absolutely devastating case of psoriasis and psoriatic arthritis. While exercise is typically beneficial, in a case this severe, it is ridiculous to suggest that exercise would have made a significant difference. The treatments at that time were simply inadequate, particularly for psoriatic arthritis. Today they are far better—including some that can even stop the progression of the disease—and yet many people are still unable to find effective relief.
Ironically, taking the author’s statements about his aunt at face value, it was the same forces in society that led his grandparents to shelter his aunt that also made the family rich: our nation’s obsession with physical appearance. If people were more accepting of physical differences or ‘imperfections,’ his aunt would have not been as isolated, but Americans would have been less interested in purchasing the pink packets of fake sugar. Even today, some people give dirty looks to people with psoriasis, to people with psoriatic arthritis … and to overweight people. So some parents will keep overprotecting their children with psoriasis, and many people will keep buying the pink (and blue and yellow) packets to try to be slim.
America’s obsession with physical appearance, then, made his family rich, and if the author is to be believed, it turns out America’s obsession with physical appearance set in motion a chain of events with an aunt with psoriatic disease that ultimately got him disinherited from that family fortune.
Now that’s a heartbreak.
Let’s hope the book’s coverage of psoriasis is improved—or at least fact-checked--for the paperback edition.
A final note: before you go, please join the battle for psoriasis patients.
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