Showing 1 - 10 of 734 Nonfiction annotations

Summary:

Maybe You Should Talk to Someone:  A Therapist, Her Therapist, and Our Lives Revealed is a memoir that takes the reader behind the closed doors of therapists’ offices and into the relationships that are formed between therapists and their patients.  The author and psychotherapist Lori Gottlieb, most familiar to readers as the writer of The Atlantic’s “Dear Therapist” column, explores the science, the role, and the goals of psychotherapy through her first-person narration.  The memoir is written chronologically with occasional flashbacks and is broken up into four parts, each progressively exposing more about Gottlieb’s and her patients’ experiences.

Though written by a therapist, the book approaches the therapeutic relationship from all angles.  Just as we see Gottlieb in her role as a therapist in Los Angeles, we also see her on the other side of the couch as a patient.  Coming to therapy in the midst of a breakup, she details her own struggles and relationships.  Interspersed between her sessions with Wendell, a therapist she deftly describes as one from “Therapist Central Casting,” and her own appointments with patients is Gottlieb’s long journey to becoming a therapist (including brief stops in Hollywood and in medical school) and how she came to understand the power of interpersonal relationships. 

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Summary:

Elizabeth Siegel Watkins reports on the use of estrogen alone and in combination with progestin for women during menopause and after menopause from the 1890s until the book was published in 2007. She concentrates on the sixty years between 1942 and 2002. The event Watkins uses to mark 1942 as an important moment is the U.S. Food and Drug Administration (FDA) approval for the estrogen product Premarin as hormone replacement therapy (HRT) in women with menopause symptoms. The event she uses to mark 2002 is the release Women’s Health Initiative (WHI) findings that showed estrogen is not the “elixir of life” that many thought it was then.  

Watkins builds her story off the trajectory of estrogen use during this sixty-year period, which spanned two peaks followed by two crashes. The estrogens for HRT first crested in the early 1970s before its use dropped dramatically in 1975 on uterine cancer fears. Estrogen use began to rise in the early 1980s on regained confidence from combined use with progestin to reduce uterine cancer risk and from hopes that bone loss could be prevented and even reversed. This resurrection continued through the 1990s as estrogen use during and after menopause became “associated with reduced risk of colon cancer, prevention of tooth loss, lower incidence of osteoarthritis, increase in bone mass, reduced risk of Alzheimer’s disease, and lower rates of death from all causes” (p. 241). 
 

Based on surveys of prescribers and prescription data during this time, Watkins concludes that “physicians who saw menopausal women as patients were…enthusiastic prescribers of HRT” (p. 244). They remained enthusiastic, making Premarin the most prescribed pharmaceutical product through much of the 1990s and until 2002 when the WHI trial was stopped three years early because it showed that HRT failed to produce the expected benefits, and even worse.
Women who took the estrogen–progestin pills, as compared with those in the control group who took placebo pills, increased their risk of breast cancer by 26 percent (relative risk of 1.26), coronary heart disease by 29 percent (1.29), stroke by 41 percent (1.41), and pulmonary embolism (blood clot) by 213 percent (2.13). (p. 271)
The investigators advised clinicians based on these results, that HRT “should not be initiated or continued for the primary prevention of coronary heart disease” (p. 271). Watkins quotes an editorial from the Journal of the American Medical Association that went further in saying that the trial “provides an important health answer for generations of health postmenopausal women to come—do not use estrogen / progestin to prevent chronic disease” (p. 273). HRT prescriptions plummeted.  

These clinical inputs into the trajectory of estrogen are just the bare bones of estrogen history. Watkins fills in the story: 
The story of estrogen is woven from several strands: blind faith in the ability of science and technology to solve a broad range of health and social problems, social and cultural stigmatization of aging, shifting meanings and interpretations of femininity and female identity, and the pitfalls of medical hubris in the twentieth century. (p. 1)
Watkins weaves these strands into the story of estrogen, which she tells in a chronological fashion, often as the subjects of individual chapters. Some include: the implications of rising feminism; pharmaceutical company promotional activities; the roles of patient advocacy organizations; FDA requirements for patient information about prescription drugs; generational differences in views of menopause; evolving research methods and evidence standards; and cultural shifts and mainstream media influences. 

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Annotated by:
Galbo, Sebastian

Primary Category: Literature / Nonfiction — Secondary Category: Literature / Nonfiction

Genre: Criticism

Summary:

In Death is But a Dream, Christopher Kerr, MD, PhD, the Chief Executive Officer and Chief Medical Officer of Hospice & Palliative Care Buffalo, shares his patients’ end-of-life dreams and visions. The content and intensity of these dreams vary, but often center on patients’ transient meetings with predeceased loved ones, offering a deeply spiritual sense of peace during periods of physical suffering. 

Using patient interviews, Kerr’s book does not fetishize dream events as ghostly commotions or in terms of pseudo-mysticism, or insist on using a religious framework for their interpretation, explaining rather that bearing witness to and legitimizing end-of-life dream experiences constitute a new ethical imperative in the practice of palliative care: “A true holistic approach to patient care must also honor and facilitate patients’ subjective experiences and allow them to transform the dying process from a story of mere physical decline to one of spiritual ascension” (Kerr 28). Case after case, his research documents that because end-of-life dreams provide patients with a singular emotional and psychological comfort that no palliative medication can simulate, hospice professionals need to validate patient dreams by listening carefully and compassionately. 

With this in mind, end-of-life dreams serve as a kind of counter-narrative to dominant cultural understandings and representations of human experiences in hospice, specifically stereotypes of terminally ill individuals as being incapable of meaningful communication, creativity, and understanding. Kerr’s patients’ narratives reveal that end-of-life dreams and visions are not trauma-inducing experiences or instances of religious prophecy, but “help reframe dying in a way that is not about last words and lost love but about strengthened selves and unbreakable bonds across lives” (142). 

Death is But a Dream 
upends medical research, or certain “limitations of science,” that oversimplifies end-of-life dreams by attributing them to neurological deterioration, oxygen deprivation, and the side effects of pain management medication (11). The general lack of rigorous, serious-minded research in end-of-life dream experiences is inseparable, in part, from institutionalized medicine’s “inability to see dying as anything but a failure” which has produced a healthcare system that “reflects a limited view of the totality of the dying experience” (7). The patient accounts that Kerr documents, however, reveal an undeniable dimension of human experience at life’s end whose complexities may be well beyond the reaches of full scientific understanding. End-of-life dreams seem to be part of an elaborate system of compensation (to borrow a term used by Siddhartha Mukherjee), as the mind works overtime to activate and animate certain memories to diminish the physical realities of dying. “There is an adaptation—substantive, spiritual yet cognitively meaningful,” writes Kerr, “a mechanism through which the patient can emerge from the dying process with a positive psychological change” (69). Indeed, the mystery of end-of-life dreams—their visions of loved ones; of seeking forgiveness, healing, and understanding within weeks, sometimes days, of one’s death; of comforting apparitions and visitations—points to a miraculous capacity within the human heart that eases the life-to-death transition.

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A dramatic prologue depicts Joan Kleinman screaming and hitting her husband Arthur in bed. She is ill with Alzheimer’s disease and does not, for that moment, recognize him. The following chapters provide a long flashback, beginning with Arthur’s family background, his youth as a tough street kid in Brooklyn, his medical education, and his marriage to Joan. We learn of their work in China, travels, and professional success. Arthur gradually realizes that the US health care system has become “a rapidly fragmenting and increasingly chaotic and dysfunctional non-system” (p. 126). Further, he sees a reductive focus on patients as mere biological entities, ignoring their personal, familial, and cultural natures. As a result, “Caregiving in medicine has gone from bad to worse.”

Joan suffers from an atypical kind of Alzheimer’s that increased over “that dismal ten years” (p. 156) with Arthur providing care to her, at cost to himself. There is no home health aide, no team approach with doctors, indeed no wider interest in her care other than the state of her diseased brain. Kleinman vividly describes the toll on her and on him.

Kleinman is aware of the privilege he has as a Harvard doctor, well known for his psychiatric work, his teaching and writing, and his wealth—in contrast to other patients and families. Some patients go bankrupt from medical bills.

Visits to nursing homes reveal a wide range of social conditions, contexts, and levels of care; the best have a sense of “moral care” (p. 200). Joan’s final days are hard. Supportive family members agree to her living will and healthcare proxy for morphine pain control only. She dies, apparently “at peace” (p. 232).

In the last pages Kleinman introduces the notion of “soul” as “essential human interactions” (p. 238). He discusses some of the limits of medicine (see paradoxes below) but also praises local efforts to improve humane care, such as team approaches, uses of narrative medicine, and medical/health humanities programs.  

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The Edge of Every Day

Sardy, Marin

Last Updated: Jan-25-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Edge of Every Day is the memoir of a woman who comes from a “multiplex” family, in which schizophrenia is manifested in successive generations.  

The book consists of a series of essays.  Some, on topics ranging from gymnastics to building altars, were first published independently and do not appear (at least at first glance) to be linked. The choppy effect this produces speaks to the disorganized thinking that psychotic persons experience.  Other essays propel the tragic narrative of family members slipping into psychosis. At the age of ten, the author Marin Sardy, watches as the “shapeless thief” of schizophrenia steals her mother’s personality away.  Later, as she reaches her thirties, she witnesses her younger brother succumb to an even more pernicious illness.   

Despite Sardy’s mother’s conspicuous symptoms, (she advises her daughter to move to Pluto and informs her that her father has been swept away in a tsunami and replaced by another man), she functions just well enough to avoid being compelled to accept treatment. Thus, no one can stop her from going through a large inheritance and becoming destitute.  

Sardy’s brother Tom suffers his first psychotic break in his 20’s and then rapidly deteriorates.  He repeatedly “cheeks” his meds and falls through the cracks of Anchorage’s mental health system. The author and her family scour the streets, hoping to lure him inside for a shower or hot meal. As the weather worsens, they can only hope he will land in prison if it means not being exposed to the Alaskan elements.  Ultimately, the young man, who once sailed through college with A’s, commits suicide in the bathroom of a psychiatric facility. 

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Annotated by:
Davis, Cortney

Primary Category: Literature / Nonfiction

Genre: Journal

Summary:

Nicolas Diat is a French journalist who, over the course of many months, traveled throughout France visiting a number of monasteries.  Because monks live their lives in many ways preparing for death, for eternity, Diat wondered if they had special insights about our final days on earth. "A Time To Die" contains a foreword by Robert Cardinal Sarah; comments by the author ("Extraordinary Stories); eight chapters, each the story of a particular monastery and particular monks; an epilogue; and closing remarks by the author.

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Michael Pollan, a journalist who is known for his work on food, takes on mind-altering drugs, or more specifically, psychedelics. According to Pollan, “after several decades of suppression and neglect, psychedelics are having a renaissance” (p. 3). His aim is to tell “the story of this renaissance” (p. 4). 

Pollan pegs the beginning of the renaissance to three events in 2006. The first was the symposium surrounding the one–hundredth birthday celebration of Albert Hoffman, who is credited with discovering LSD (he was in attendance and lived for another two years). The symposium put a spotlight on a few studies of psychedelics that inspired other researchers and practitioners to enter or stay in the field. The second event was a U.S. Supreme Court decision permitting importation of a banned psychedelic substance for religious purposes, which effectively reanimated federal government recognition of psychedelic drugs. The third event was the publication of a well-received study showing the psychological effects of certain psychedelic drugs, and in so doing, conferred some credibility and encouragement for further study (and use). Psychedelics were beginning to inch their way from counterculture to mainstream culture.

Before Pollan picks up on what happens after the eventful year of 2006, he goes back to the early 1950s when psychedelics first attracted attention as treatment for “addiction, depression, obsessive-compulsive disorder, schizophrenia, autism, and end-of life anxiety” (p. 141). He quotes researcher Stephen Ross, who asserts that during this time, “there had been forty thousand research participants and more than a thousand clinical papers!…Some of the best minds in psychiatry had seriously studied these compounds in therapeutic models, with government funding” (pp. 142-143). The trajectory towards therapeutic uses would come to an end in the 1960s when “a moral panic about LSD engulfed America, and virtually all psychedelic research and therapy were either halted or driven underground” (p. 185). Pollan identifies several contributing factors to the precipitous reversal in the status of psychedelics. Among them were their associations with Timothy Leary (“Turn on, tune in, drop out”) and with counterculture movements that were seen as threats to mainstream society in general. The era ends in 1970 when psychedelics were made illegal in the U.S., after which they were largely forgotten. They began to reappear in the 1990s, which rekindled an interest in them that would reach an inflection point in 2006.

Bridging the mid-twentieth-century history Pollan provides and the era commencing in 2006 he describes in detail later, is a chapter reporting on his own experiences with psychedelics. Pollan arranged three separate “trips” with three individual psychedelics: psilocybin, LSD, and the little-known 5-MeO-DMT, or “The Toad.” He carefully chose a tour guide for each one. Pollan experienced what he interpreted as a dissolution of his ego, which made more room for his consciousness: “I was present to reality but as something other than my self” (p. 264). He also reported spiritual and mystical experiences, which surprised him because he is not religious in much of any way, and he found others who had similar experiences.  
Even the most secular among them come away from their journeys convinced there exists something that transcends a material understanding of reality: some sort of a ‘Beyond.’ (p. 85)  
The term “spiritual” for Pollan became “a good name for some of the powerful mental phenomena that arise when the voice of the ego is muted or silenced” (p. 288). 

In another chapter bridging the past and the present, Pollan covers the neuroscience of psychedelics and the current understanding of how the brain works. The chapter will appeal mostly to neuroscientists, pharmacologists, and clinicians. It’s not required to appreciate what the book offers on the whole. 

Pollan devotes a chapter to ongoing investigations into clinical uses for psychedelics in near death, addiction, and depression. These investigations had moved into mainstream biomedical research institutions. Results were encouraging enough to generate additional studies, expand treatment programs, and motivate the U.S. Food and Drug Administration (FDA) to push researchers for more information on depression in particular. Pollan also reports that “dozens of medical schools have asked to participate in future trials, and funders have stepped forward to underwrite those trials” (p. 350). 
 

In the final chapter, Pollan recognizes that despite the momentum behind mainstream biomedicine interest in psychedelics, established clinical and regulatory frameworks pose daunting challenges for broad-based adoption anytime soon. That aside, Pollan argues for the use of psychedelics in situations that are not limited to health problems per se, but also for “the betterment of well people,” which was also an interest of early researchers. To Pollan, the betterment comes from the effect of psychedelics to expand consciousness. 
Most of the time, it is normal waking consciousness that best serves the interests of survival—and is not adaptive. But there are moments in the life of an individual or a community when the imaginative novelties proposed by altered states of consciousness introduce exactly the sort off variation that can send a life, or a culture, down a new path. (p. 407) 
His conclusion is that without the assistance of psychedelics, the vastness of the mind and the mysteries of the world can never be known. Psychedelics for everyone! 

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Responding to a shortage of doctors in rural areas in 2013, Dr. Virji, a Muslim, moved from the urban East coast to a small town in Minnesota.  Welcomed at first, he and his family began, after Trump's election in 2016, to experience withdrawal, suspicion, and outright racism in his own and neighboring towns, despite having established solid, trusting relationships with patients.  His children were being ostracized in school.  Discouraged, he took steps to accept a job in Dubai, but changed his mind after a local pastor invited him to speak in her church to correct common misconceptions about Muslims and to engage his neighbors in deeper dialogue about their differences and commonalities.  The lecture was so successful, he took it further into other towns and parts of the country.  He has stayed in Minnesota and witnessed change because of this invitation and his candid, open-hearted response. 

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Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

A British physician-writer reflects on her topsy-turvy medical training emphasizing the mental and emotional burden of becoming a doctor. In 22 brief chapters with titles including "The Darkest Hour," "Buried," and "The Wrong Kind of Kindness," a struggle between hope and despair furiously plays out - in patients, hospital staff, and the narrator.

Dr. Jo (as one patient calls her) remembers interviewing for medical school admission, the difficulty dissecting a cadaver, starting lots of IV's, dutifully toting an almost always buzzing pager, and breaking bad news. She shares with readers her own serious car accident with resulting facial injuries. She comments on the underfunded UK National Health Service (NHS) that is "held together by the goodwill of those who work within it, but even then it will fracture" (p104).

Anecdotes of memorable encounters are scattered throughout the narrative: a fortyish woman in the emergency department who describes a fast pulse and sense of impending doom diagnosed as having an anxiety attack who ten minutes later suffers a cardiac arrest, a man with severe schizophrenia, a suicide, an elderly blind person, a young woman with metastatic breast cancer.

But the lessons that have stuck with her are primarily dark and somber ones. "Sacrifice and the surrender of the self are woven into the job" (p77). She realizes that "perhaps not all good doctors are good people" (p125) and that as wonderful and essential as the virtue of compassion is, "compassion will eat away at your sanity" (p16). She chooses psychiatry as a specialty where kindness, empathy, creating trust with patients, and careful listening work wonders for people. "I learned that saving a life often has nothing to do with a scalpel or a defibrillator" (pp13-14).

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Richard Holmes refers to this book as his “account of the second scientific revolution, which swept through Britain at the end of the eighteenth century, and produced a new vision which has rightly been called Romantic science” (p. xv). He pins the first scientific revolution to the seventeenth century and centers it on the work of Newton, Hooke, Locke, and Descartes. He brackets the second around 1768, when James Cook began his voyage circumnavigating the world, and 1831, when Charles Darwin began his voyage to the Galapagos islands. Holmes calls this period “The Age of Wonder.” 

Cook’s voyage carried Joseph Banks among its crew. Banks, a young man of great wealth and privilege, joined the expedition as a botanist to assist in the collection of botanical and zoological specimens from stops in the southern hemisphere. He was successful in this endeavor, and made observations about island life along the way (especially while on Tahiti). A few years after his return, he became the president of the Royal Society and would remain so for the next forty–two years.

The Society offered scientists (known then as “natural philosophers”) a place to publish papers, present findings, gain notoriety, receive funding, and develop networks. In his role as President, Banks was connected to many of the scientists included in the book. 

William Herschel and Humphrey Davy are the most prominent figures Holmes covers. Herschel was an accomplished musician and amateur astronomer before he built telescopes that helped him see, characterize, and record heavenly bodies never seen before. While conventional thinking of the time considered the universe to be static, placed by a divine hand, Herschel viewed it as continually evolving. Holmes also gives Herschel’s sister, Caroline, her just due as first his assistant and then as a noted astronomer in her own right.

Holmes focuses on Davy’s more well-known advances in chemistry: finding new elements; analyzing human effects of gasses comprising “common air” and “factitious airs” (e.g., nitrous oxide); inventing a safety lamp for miners; and applying the voltaic battery to chemical analysis. Holmes also details Davy’s role as a popularizer of science through well-received public lectures.

Aside from a chapter on Mungo Park’s ill-fated expedition to Africa, the other chapters have less focus on individuals and more on notable events. One concerns the first flights of hot air balloons, and another on the speculations of electricity as a life force that led to Mary Shelly’s novel, Frankenstein; Or, The Modern Prometheus. The final two chapters are in the service of Holmes’s view that “Science is truly a relay race, with each discovery handed on to the next generation” (p.468). He identifies the next generation of scientists and pays particular attention to William Herschel’s son, John, and to Davy’s protégé, Michael Faraday. Both went on to accomplished and celebrated careers. 

Holmes embeds the historical scientific developments and legendary figures into the ordinary daily life and human follies of the time. He describes how scientists and explorers sought public and private funding, and how they collaborated with one other on some occasions and competed with one another on others. We read of court intrigues, societal jostling, courtships and marriages, extramarital affairs (chaste and tawdry), and family relationships (devoted and fractious).  

A broader context Holmes provides involves the interplay among the scientists and explorers he covers and some of the important figures in literature, poetry, and art of Romantic era. Samuel Coleridge, William Cowper, John Keats, Mary Shelley, Percy Bysshe Shelley, Robert Southey, and Joseph Wright of Derby among others make appearances in the stories Holmes tells. He details the friendships between them and the influences they had on each other.

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