Funny business: the novelist Miriam Toews. Photo: Vince Talotta/Toronto Star via Getty
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Funny, defiant and furious: the tangled tale of two sisters

In Miram Toews’s new novel, the ability of literature to act as an antidote to despair is tested to the limit.

All My Puny Sorrows 
Miriam Toews
Faber & Faber, 336pp, £12.99

The Girls from Corona del Mar 
Rufi Thorpe
Hutchinson, 256pp, £14.99

“It was my father and my sister who constantly beseeched my mother and me to read more, to find succour for life in books, to soothe our aches and pains with words and more words,” remarks Yolandi (Yoli) Von Riesen, the narrator of Miriam Toews’s new novel, in which the ability of literature to act as an antidote to despair is tested to the limit.

Among the astonishing quantity of books referenced in this most bookish of fictions is Richard Holmes’s memoir Footsteps, which Yoli reads “as though somewhere in its pages are contained the directions to hell’s only exit”. The passage that particularly catches her attention is Holmes’s portrait of Mary Wollstonecraft: “There was something, I suppose, like a wild waterfall in the headlong, broken, plunging quality of Mary’s life.”

The description applies with eerie exactness to Yolandi’s beloved elder sister, Elfrieda, who is brilliant, beautiful and broken. Alas, it doesn’t help solve Yolandi’s urgent dilemma: how to answer Elfrieda’s request that Yoli accompany her to Switzerland, where she intends to end her life.

Suicide has become for Elfrieda a desire as compelling as the passion for music that drove her as a rebellious teenager to flee the chilly disapproval of her small Canadian Mennonite community and seek a career as a concert pianist. Now in her forties, she is a celebrity with an international career, a devoted manager and a family that is as determined to prevent her from dying as she is to succeed.

If you were to compare the sisters’ circumstances, it would be Yolandi rather than Elfrieda who might seem the more likely to succumb to depression. By contrast with Elfrieda’s elegant trajectory to private and public success, Yolandi’s life has been a muddled affair. She is large and freckled, rather than small and exquisite. Her eyelashes, unlike Elfrieda’s, are not so long that snow settles on them in winter. She is the author of a not-very-successful series of young adult novels. She has a teenage son, Will, and daughter, Nora, from two failed marriages.

What time she can spare from the exacting process of thwarting Elfrieda’s repeated suicide attempts is spent in a series of unsatisfactory love affairs. It is a life punctuated by small failures; yet through Yoli’s character runs a streak of resilient, mocking optimism that acts as a counter-charm against the urge to self-annihilation that is an ingrained family trait.

Suicide runs in the Von Riesen family. Various cousins took their own lives and Elfrieda’s and Yoli’s father, an idealistic primary school teacher, killed himself by kneeling in front of a train. These are not imagined events. In her previous novels and in an award-winning memoir of her father, Swing Low, Toews has described her childhood in a Canadian Mennonite community and her father’s suicide. Her elder sister, Marj, killed herself in 2010, having asked Miriam to help end her life.

“For me, writing is an act of survival,” Toews has said. Her novel – funny, defiant and, when it comes to the heroic in­difference of the medical staff charged with Elfrieda’s care, furious – is an unsparing anatomy of the battle between the will to live and the will to die. Elfrieda’s musical talent apparently has no power to attach her to life – on the contrary, it seems to enhance her sense of fragility (she shares with King Ludwig I’s daughter Princess Alexandra of Bavaria the conviction that she has a glass piano inside her that may break at any moment). But words represent a “mixed message of hope, reverence, defiance and eternal aloneness”. As a teenager, Elfrieda planned to scrawl “AMP”, representing the words “all my puny sorrows”, a phrase from a poem by Coleridge, on landmarks across town as an act of defiant individualism. Her penultimate act is to ask her husband to fetch her some books from the library. “Books,” thinks Yoli, “are what save us. Books are what don’t save us.”

The theme of salvation by narrative haunts Rufi Thorpe’s debut novel, The Girls from Corona del Mar, a coming-of-age fiction that explores the unequal contest between human will and indifferent fate. Mia and Lorrie Ann are teenagers growing up in the 1990s in the Californian coastal hamlet of Corona del Mar. As the novel begins, Mia seems to be heading for a crash. She is 15 years old and recovering from an abortion, having lost her virginity and become pregnant in the same moment.

Lorrie Ann, by contrast, has all the virtues of a fairy-tale heroine. She is beautiful, clever, nice and – almost unprecedentedly in Corona del Mar – the child of a stable family. “In a way,” Mia reflects, “Lorrie Ann made me everything I am, for my personality took shape as an equal and opposite reaction to who she was . . .”

It is the destiny of fairy-tale heroines to suffer and there is something gleeful about the way in which Thorpe sets about heaping misfortune on Lorrie Ann. “It was,” Mia thinks, “like some bizarre postmodern rendition of Job.” From an unplanned pregnancy, which Lorrie Ann virtuously declines to terminate, there extends a grim sequence of catastrophe. While Mia flourishes, her friend suffers a series of lurid mishaps as elaborate and undeserved as the fanciful horrors of 17th-century revenge tragedy.

As in all good fairy tales, there is a slightly improbable ending that offers the possibility, if not of happiness ever after, at least of respite from misfortune. There are signs in Thorpe’s novel of a writer finding her voice: the binary structure is a trifle heavy-handed and the conclusion simplistic. Yet her depiction of female friendship is engaging and sharply observed. Seldom has Schadenfreude been more appetisingly packaged. 

Jane Shilling is a book critic for the Telegraph and the author of two books: The Fox in the Cupboard and The Stranger in the Mirror, a memoir of middle age, published in 2011. She writes on books for the New Statesman. 

This article first appeared in the 20 August 2014 issue of the New Statesman, What the Beatles did for Britain

Davide Restivo at Wikimedia Commons
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Scientists have finally said it: alcohol causes cancer

Enough of "linked" and "attributable": a new paper concludes that alcohol directly causes seven types of cancer.

I don't blame you if you switch off completely at the words "causes cancer". If you pay attention to certain publications, everything from sunbeds, to fish, to not getting enough sun, can all cause cancer. But this time, it's worth listening.

The journal Addiction has published a paper that makes a simple, yet startling, claim: 

"Evidence can support the judgement that alcohol causes cancer of the oropharynx [part of the throat], larynx, oesophagus, liver, colon, rectum and [female] breast"

So what's especially significant about this? 

First, scientists, unlike journalists, are very wary of the word "causes". It's hard to ever prove that one action directly led to another, rather than that both happened to occur within the same scenario. And yet Jennie Connor, author of the paper and professor in the Preventive and Social Medicine department at the University of Otago, New Zealand, has taken the leap.

Second, alcohol not only causes cancer of one kind – the evidence supports the claim that it causes cancer at seven different sites in our bodies. There was weaker evidence that it may also cause skin, prostate and pancreatic cancer, while the link between mouth cancers and alcohol consumption was the strongest. 

What did we know about alcohol and cancer before?

Many, many studies have "linked" cancer to alcohol, or argued that some cases may be "attributable" to alcohol consumption. 

This paper loooks back over a decade's worth of research into alcohol and cancer, and Connor concludes that all this evidence, taken together, proves that alcohol "increases the incidence of [cancer] in the population".

However, as Connor notes in her paper, "alcohol’s causal role is perceived to be more complex than tobacco's", partly because we still don't know exactly how alcohol causes cancer at these sites. Yet she argues that the evidence alone is enough to prove the cause, even if we don't know exactly how the "biologial mechanisms" work. 

Does this mean that drinking = cancer, then?

No. A causal link doesn't mean one thing always leads to the other. Also, cancer in these seven sites was shown to have what's called a "dose-response" relationship, which means the more you drink, the more you increase your chances of cancer.

On the bright side, scientists have also found that if you stop drinking altogether, you can reduce your chances back down again.

Are moderate drinkers off the hook?

Nope. Rather devastatingly, Connor notes that moderate drinkers bear a "considerable" portion of the cancer risk, and that targeting only heavy drinkers with alcohol risk reduction campaigns would have "limited" impact. 

What does this mean for public health? 

This is the tricky bit. In the paper, Connor points out that, given what we know about lung cancer and tobacco, the general advice is simply not to smoke. Now, a strong link proven over years of research may suggest the same about drinking, an activity society views as a bit risky but generally harmless.

Yet in 2012, it's estimated that alcohol-attributable cancers killed half a million people, which made up 5.8 per cent of cancer deaths worldwide. As we better understand the links between the two, it's possible that this proportion may turn out to be a lot higher. 

As she was doing the research, Connor commented:

"We've grown up with thinking cancer is very mysterious, we don't know what causes it and it's frightening, so to think that something as ordinary as drinking is associated with cancer I think is quite difficult."

What do we do now?

Drink less. The one semi-silver lining in the study is that the quantity of alcohol you consume has a real bearing on your risk of developing these cancers. 

On a wider scale, it looks like we need to recalibrate society's perspective on drinking. Drug campaigners have long pointed out that alcohol, while legal, is one of the most toxic and harmful drugs available  an argument that this study will bolster.

In January, England's chief medical officer Sally Davies introduced some of the strictest guidelines on alcohol consumption in the world, and later shocked a parliamentary hearing by saying that drinking could cause breast cancer.

"I would like people to take their choice knowing the issues," she told the hearing, "And do as I do when I reach for my glass of wine and think... do I want to raise my risk of breast cancer?"

Now, it's beginning to look like she was ahead of the curve. 

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.