Book Review - The Trembling Mountain

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BOOK REVIEW

The Trembling Mountain

A Personal Account of Kuru, Cannibals, and Mad Cow Disease

by Klitzman

Plenum Press, 1998

Reviewed by Jeanine Barone

(Posted November 27, 1998 . Issue 43)

Review

There is a recurring theme in physician Klitzman's book The

Trembling

Mountain: A Personal Account of Kuru, Cannibals, and Mad Cow Disease. When

an

epidemic strikes, whether in an industrialized society or in a Stone Age

tribe,

responses are the same: denial and a refusal to alter ingrained behaviors

that

are responsible for spreading the pathogen.

Klitzman gained experience with plagues after spending time in Papua New

Guinea, where kuru (a rare form of encephalopathy that - like bovine

spongiform

encephalopathy, also known as mad cow disease - is believed to be caused by

pathogenic proteins called prions) killed up to two-thirds of the

population

in

some villages. He took a year off between college and medical school in

1981

to

conduct epidemiological research for D. Carleton Gajdusek, who won a Nobel

Prize for his work with kuru and a related dementia called

Creutzfeldt-Jakob

disease (CJD). After his fieldwork ended, the author returned to the United

States to study medicine around the time when the first cases of AIDS were

reported. According to Klitzman,In all three [kuru, mad cow disease, and

AIDS],

people at risk feared the disease but had difficulty understanding the

disease

mechanisms, accepting long incubation periods, and changing deeply rooted

behaviors. Among these behaviors were the eating of human flesh, the eating

of

beef, the practice of unsafe sex, and the use of dirty needles to inject

narcotics and other drugs.

The Trembling Mountain reads like a scientific travelogue touching on the

connection between kuru and mad cow disease. It also provides a slim

description of a Stone Age people, the Fore. The book is not a detailed

scientific treatise; rather, Klitzman aims to take readers on a journey -

the

same journey he took - to explore the ways in which culture molds a

person's

view of death and disease. This trip was Klitzman's rite of passage, during

which he learned to see patients as an anthropologist sees them, rather

than

as

a biologist might.

In the local language, the word kuru means to tremble, a reference to the

disease-induced tremors that progress until the afflicted can neither walk

nor

eat. As their central nervous systems degenerated, patients lost the

ability

to

speak, were said to erupt in fits of laughter (hence its nickname the

laughing

death), and eventually died. Klitzman describes how this fatal disease

spread

as a result of the Fore's cannibalistic feasts. When someone died, the body

was

cut up, wrapped in banana leaves or a bamboo tube, steamed, and eaten. The

brain - the most highly prized portion and the organ with the greatest

concentration of infectious prions - was always given to the nearest female

relative, who shared it with her children. Though some anthropologists

claim

this cannibalism never existed, Klitzman provides numerous anecdotes

consistent

with the practice. In one instance, an old woman approached him at a

funeral

to

tell him that his arm would probably taste very good. In Papua New Guinea,

Klitzman tracked the remaining kuru cases and observed that the infection

was

declining. He proceeded to determine the longest incubation period, the

virulence of the infectious agent, and other factors that played a role in

determining who became ill. These factors included age, genes, dose, and

strain; for instance, anyone born after the practice of cannibalism ceased

in

1959 did not develop kuru. At the time, researchers believed that kuru was

spread primarily not by eating contaminated tissue but by touching infected

mucous membranes and thereby contaminating one's hands. This made sense

considering that, with no soap or tap water, women often didn't wash for

weeks

after a feast. It was Klitzman's job to prove that the disease was in fact

spread by cannibalism.

At first, Klitzman was awkward, frightened, and frustrated as he examined

dying

patients and realized that he could do little more than offer them and

their

families a bar of soap and a blanket. He was quite naive, romanticizing

Papua

New Guinea as a tropical paradise and believing that the Fore would support

his

scientific research. Instead, he encountered problems similar to those in

the

West. For one thing, the people were hardly innocent.Cultures differ in how

they approach essential human needs, but the basic psychological types of

individuals I encountered here [lying, materialistic, and conniving people]

resembled those in New York, says Klitzman. His guides had no idea what it

meant to be truthful. They had no interest in his research, working only

for

the money, and used him for countless favors. The people here had no

inquisitiveness into anything beyond their hamlet or personal material

gain,

he

laments. When Klitzman mentioned the ocean on the distant horizon or that

men

walked on the moon, his guides were hardly interested.

Klitzman also recounts the frustrations involved in researching this

deadly

disease. He struggled to understand the Pidgin dialect (a combination of

English, French, German, Dutch, and Malay) and to deal with chronically

late

guides, heat, humidity, and muddy trails. He slept with biting fleas,

suffered

from intestinal parasites, conducted interviews in the rain, coped with

landslides, and trekked until he was exhausted. Patients bolted their doors

or

ran away when Klitzman visited their hamlet. Superstitious relatives

refused

to

let him see patients, take pictures, or write down their names because they

believed it would prove unhealthy. Many times he became so disgusted -

especially when he went to bed hungry or was forced to eat in the mud with

pigs

- that he wanted to quit. At other moments, he relished the beauty and

solitude

of the mountain hikes and the simplicity of his life.

Despite the deaths, cannibalism continued among the Fore because they

believed

that kuru was caused by sorcery. They only stopped under the threat of

arrest

by the government. In the end, Klitzman couldn't convince them that kuru

was

caused by an infectious agent; the Fore wanted to see the cause, but all he

could tell them was that it was too small to see. The tribe's belief in

sorcery

was so entrenched that even his guides, who worked with Western scientists,

and

teachers in the local school held these views. One local man who claimed he

could cure kuru blamed his failures on patients' not following his advice.

Much

later, Klitzman realized that this is no different from doctors in the

United

States blaming patients - rather than inappropriate treatment - for their

failures.

The book begins and ends with warnings about mad cow disease. People deal

with disease, Klitzman asserts, by rationalizing (believing that kuru is

due

to

sorcery or that AIDS only occurs in gay men) so that they can continue

practicing long-held behaviors. The British didn't want to stop eating

beef,

the Fore didn't want to stop cannibalism, and people wanted to continue

practicing unsafe sex. As the AIDS pandemic spread, I saw how Western

reactions

resembled Stone Age responses to kuru, notes Klitzman. Some scientists

believe

kuru may have originated from a feast in which someone infected with CJD

was

eaten. CJD is now known as the disease that people contract by eating beef

infected with mad cow disease. Throughout the book, Klitzman warns that

although no human cases of mad cow disease have been proven in the U.S., a

number of cases traced to Britain have been identified in continental

Europe.

Klitzman also asserts that eating beef in the U.S. may be dangerous and

that

the rise in the incidence of Alzheimer's disease may simply reflect a

misdiagnosis of CJD.

It wasn't until mad cow disease struck that Klitzman's research was of any

practical value in the West. The incredibly long incubation periods of

these

prion diseases struck Klitzman when he examined a patient who developed

kuru

41

years after a feast.I was sad, not just for him, but for Britain and the

world.

People would still die in Britain of mad cow disease more than 40 years

after

they ate their last infected hamburger, warns Klitzman.

Jeanine Barone is a nutritionist and exercise physiologist who specializes

in

writing about travel, fitness, food, and health.

Excerpt

I had thought the natives primitive. Yet in the worlds of medicine and

psychiatry, I saw many similarities to how New Guineans had understood and

dealt with disease and the world. New Guinea gave me bases of comparison

for

all else I thought and saw - not only in medicine and psychiatry, but more

broadly as well. My experiences there freed me somewhat from the

constraints

of

Western culture: I took less for granted, and accepted less as given (which

proved both a benefit and a handicap).