Influenza and Inequality: One Town’s Tragic Response to the Great Epidemic of 1918

In The Tender Cut, Patricia Adler and Peter Adler present the largest, to date, qualitative sociologically-grounded investigation of the lived experience of a non-clinical population of people who self-injure. Drawing on data from over 135 in-depth life history interviews, the authors go beyond the interpersonal and psychological dynamics behind the ‘‘self-injurer’’ to examine the larger world that situates, provokes, and even reinforces the need to engage in self-injury for people who clearly are not a homogeneous population. The social transformation of the practice of self-injury as it has increased in social acceptability and moved beyond the act of an isolated individual to that of a person embedded in a ‘‘real’’ or cyber community (where they note it is still possible for a self-injurer to feel excluded) is documented, as well as the self-presentation of self-injurers on the internet (e.g., the roles different people take in the groups) and the relationships between people who self-injure. The patience, empathy, and understanding of the authors is also evident as they neither demonize the act, nor stigmatize or alienate those who shared their stories; rather they expose in a dignified manner the turmoil, angst, fear, impulsivity, ritual, stress and pain, among other factors, behind the act of self-injury. The strengths of the book are multifold. Adler and Adler present self-injury (broadly defined to include behaviors such as cutting, burning, hair pulling, picking, and bone breaking) as a way some people cope with the challenges, stresses, and difficulties they experience in life. They explain that there is no typical self-injurer or typical start to the injurious career; the only commonality among many self-injurers is the experience of stress. They note the role of social living and personal experiences or exposure in the instigation of the self-injurious career. The authors also take into account how selfinjuring has moved from a psychological ‘‘disorder’’ into a learned social trend— a ‘‘sociological occurrence’’ (p. 3) situated in subcultures and, even at times, resembling a ‘‘fad. ’’ It is established, via sampling a ‘‘sociological population’’ of self-injurers that ranged from youths to persons in their mid-fifties, that self-injury is more common among the population than the authors initially anticipated. They noted similarities and differences between the struggles of self-injurers across all ages and described the increased alienation felt by older selfcutters, as the normative attitude suggests these older self-cutters should have ‘‘grown out of it’’ (p. 34). Theoretically, the manuscript adds support to the feminist critique of the medical model’s ‘‘disempowerment of self-injurers,’’ theoretically addresses the gendered context in which self-injury is framed, and expands interactionist and other theoretical views. Although methodologically strong, the authors do not provide an overview of the demographics of their sample. Given that the experiences of people who self-injure appear, on many levels, to parallel those of people who self-harm through other means or use other negative coping behaviors (e.g., alcoholics, drug users, bulimics, anorexics, etc.) and that some interviewees were noted to practice other negative coping behaviors, extended reporting of demographics could assist the reader to substantiate the sample. Moreover, providing additional information on these explicit factors may clarify what aspects of the self-injurer experience result from their injurious career, or if some part of their experience or motivation to continue to self-injure is more appropriately viewed as a consequence of other negative coping mechanisms. The weakest point of the book is the lack of an explicitly embodied analysis of self-injury. The reader is left wondering how the scaring