Showing 11 - 20 of 23 annotations contributed by Teagarden, J. Russell

Is It All in Your Head?

O'Sullivan, Suzanne

Last Updated: Mar-17-2017
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Suzanne O’Sullivan is a neurologist in the British National Health Service. She has a particular interest in psychosomatic illnesses, and in this book, she covers what she has learned about them. O’Sullivan provides these learnings mostly from clinical experience rather than as findings from empiric studies on psychosomatic illnesses.   

Each chapter is built around one or more case studies that focus on particular psychosomatic illnesses, and include historical perspectives and various theories that might explain why they occur.  

The cases O’Sullivan uses presented themselves as seizures, paralysis, urinary tract troubles, generalized and localized pain, gastrointestinal problems, fatigue, blindness, and dystonia. Patients sometimes came to her with pre-determined diagnoses such as epilepsy, Lyme disease, chronic fatigue syndrome, myalgic encephalomyelitis, and fibromyalgia among others. O’Sullivan is emphatic that psychosomatic illnesses are not just any presentation of illness that cannot be linked to a pathological basis. Psychosomatic illnesses arise from “the subconscious mind [that] reproduces symptoms that make sense to the individual’s understanding of how a disease behaves.” (p. 83) Illness presentations that are feigned or self-inflicted (e.g., Munchausen’s syndrome) are not psychosomatic illnesses in O’Sullivan’s view.
 

Each chapter delves into some particular aspect of psychosomatic illness relevant to the case study. These include history (e.g., role of the uterus in hysteria), mechanisms at work (e.g., conversion reactions, dissociation), triggers (e.g., stress, loss, personality traits), factors (e.g., previous illness experiences), illness behavior disorders (e.g., associating illness to benign physical sensations), and the higher incidence seen among females. Though O’Sullivan teases out various characteristics and workings of psychosomatic illnesses, she admits that they remain vexing to clinicians because, “almost any function of the body can be affected in almost any way.” (p. 170)

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T.B. Harlem

Neel, Alice

Last Updated: Mar-01-2017
Annotated by:
Teagarden, J. Russell

Primary Category: Visual Arts / Painting/Drawing

Genre: Painting

Summary:

The Alice Neel painting, T.B. Harlem, can be seen at the National Museum of Women in Arts in Washington, D.C.

We are looking at a young man who has tuberculosis (TB) and who is at home recovering from a surgical procedure designed to collapse a part of his lung that is infected. He looks sick. His presentation conveys how TB can be called “consumption.” From this picture, however, we can tell that it is not just the subject’s body that is being consumed, but also his spirit and any reservoir of hope.  

The painting appeared on the cover of the June 8, 2005 issue of the Journal of the American Medical Association (JAMA).  In his accompanying essay, William Barclay, a pulmonary specialist, surmises that “thoracoplasty” was the surgical procedure used for this person. The procedure involves the removal of several ribs so that the soft tissue the ribs held up collapses upon the lung and closes it off. Barclay calls thoracoplasty “the most radical form of collapse treatment” at the time. He also notes how Neel captured the anatomical consequences of the procedure:
His body forms a graceful sigmoid curve, for a thoracoplasty always resulted in a thoracic scoliosis from the pull of the muscles on the side not operated on, with a compensatory cervical scoliosis in the opposite direction.  

A white wound dressing on the left side of the subject’s chest draws our attention because of its brightness and because the subject’s right hand is pointing to it. It’s not covering the surgical incision because that’s on his back. Barclay suggests that the dressing is covering a wound that opened up a track from the skin to the chest lining or to the lung (i.e., a fistula). The dressing takes the shape of a cross, which made the writer of the text accompanying the painting at the museum where it hangs wonder if we are to see the subject as a martyr in the form of Christ.

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Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: TV Program

Summary:

The Knick was inspired by the Knickerbocker Hospital, founded in Harlem in 1862 to serve the poor. In this 20-part TV series spread out over two seasons, the fictional Knick is somewhere in the lower half of Manhattan around 1900. The time covered during the series is not marked in any distinct way. The characters don’t age much, and although fashion and customs remain static during the series, the scope and significance of advancements that come into play were actually adopted over a longer time than the episodes cover.   

The series builds on some known history. The central character, the chief surgeon Dr. John Thackery, is modeled on a famous surgeon of the time, Dr. William Halsted, in both his surgical adventurism and in his drug addictions. The character Dr. Algernon Edwards, who is an African-American, Harvard-educated, and European-trained surgeon, is based in part on Dr. Louis T. Wright, who became the first African-American surgeon at Harlem Hospital during the first half of the 20th century.  

Storylines of human drama and folly run through the series. Among them are medical cases both ordinary and bizarre, heroic successes and catastrophic failures, loves won and lost, gilded lives and wretched existences, honor and corruption, racism and more racism. Within and around these storylines are the scientific, medical, and industrial advances of the period, as well as the social contexts that form fin de si
ècle hospital care and medical research in New York City.
 

Some of the industrial advances we see adopted by the hospital include electrification, telephone service, and electric-powered ambulances. We see that transitions to these new technologies are not without risks and catastrophes: patients and hospital staff are electrocuted, and when the ambulance batteries died -- a frequent occurrence-- many of the patients they carried died, too.

Medical advances integrated into various episodes include x-rays, electric-powered suction devices, and an inflatable balloon for intrauterine compression to stop bleeding. Thackery is a driven researcher taking on some of the big problems of the day, such as making blood transfusions safe, curing syphilis, and discovering the physiologic mechanisms of drug addiction. We see how he learns at the cost of his patients, or rather his subjects. We also glimpse movements directed at population health. For example, epidemiological methods are applied to find the source of a typhoid outbreak, which drew from the actual case of Mary Mallon (aka, Typhoid Mary). Shown juxtaposed to the advances epidemiology was then promising is the concurrent interest that was rising in eugenics and its broad application to control for unwanted groups. Research ethics and regulations were a long way off.


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Manchester by the Sea

Lonergan, Kenneth

Last Updated: Jan-09-2017
Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Lee Chandler is approaching middle age and working as a maintenance man for an apartment complex in Quincy, Massachusetts. We get a sense for his days as we watch him shovel snow from the walks, unclog toilets, fix leaks, and argue with tenants. We get a sense for his nights as we watch him at a bar drink himself into a fighting mood and then watch him fight. He returns to his sparse subterranean apartment that he shares with no one to sleep off the beer and the bruises. He’ll do it again the next day.  

Lee takes a call as he’s shoveling snow. His older brother Joe is in the hospital in Manchester. He would not get there before Joe dies. A few days later Lee finds out he’s now guardian to Joe’s teenage son Patrick. This is not a responsibility he knew about or welcomed, and one that anchors him to his hometown of Manchester. He doesn’t want to stay in Manchester. Through a series of flashbacks, we find out that it’s not the struggles that come with taking on the responsibility of a rambunctious teenager that makes him want to leave again, it’s the unspeakable tragedy he experienced there years before. He blames himself for this tragedy, as did his wife Randi, and many of the townspeople.  

Over the next few months, Lee is busy making burial arrangements for his brother, situating his nephew, and looking for work while being reminded regularly of what causes his profound suffering. He also experiences fresh assaults. One in particular is the reemergence of his now ex-wife Randi. She attends Joe’s funeral forcing him to bear the sight of her with a new husband and in the late stage of pregnancy. A little later he encounters her in town with her newborn child in a buggy. She wants to make amends for her contribution to his suffering. Lee’s response to Randi’s entreaties is gracious but lifeless, and explains how he gets through the days. He has no internal resource to muster responses to anything, good or bad. He’s hollowed out. “There’s nothin’ there,” he tells Randi.
 

We’re given no reason to expect there will ever be anything there again for the rest of Lee’s life through a conversation he has with Patrick. Lee has arranged for a family friend to adopt Patrick so that he could leave Manchester for a job in Boston. When Patrick pushes him to stay, Lee confesses: “I can’t do it. I can’t beat it. I can’t beat it.”

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The Wilderness

Harvey, Samantha

Last Updated: Dec-13-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Jake Jameson is an architect who came of age in immediate post World War II London. He grew up in “the wilderness” of the English moors and peat bogs far from London. He returns to this wilderness with a wife and an infant son, and to where his mother, a childhood friend, and many memories still live. We read about his successful career, his Jewish mother and her flight from her native Austria, his marriage to Helen and her unexpected death after about 30 years of marriage, his infidelities, his son’s incarceration in a prison he designed, his daughter’s death as a young child, and how eventually the wilderness he lived in moved from the moors to his brain. We don’t learn all of this easily because it comes in one form through Jake’s damaged memory and in another form through the tellings of more reliable witnesses. We are left in our own confused state about certain parts of story until the corrections and clarifications come later in the book. For example, we can go far into the novel thinking that Helen could have died from falling from a cherry tree until we learn near the very end that she died from a stroke, probably.

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Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

As the movie opens, the married artists Einar and Gerda Wegener are working out of their apartment in Copenhagen. The year is around 1908 and they have been married for just a few years. They do not have children as yet, but they have hopes that they would soon.  

Einar is a painter of Scandinavian landscapes and Gerda is a figurative painter. When the model for a painting Gerda is working on fails to appear one day, she asks Einar to take the model’s place. Einar would need to pose with the model’s dress and assume a feminine posture. In posing as a woman, Einar's simmering desire to become a woman comes to a boil.

At first Gerda finds Einar’s interest in posing as a woman an interesting diversion and as a means to have some fun at various social events. But, Einar becomes more and more serious about his interest in transitioning to a woman in more than just wardrobe and affect. As an early step in that direction, he takes on the name Lili Elbe and the pronoun "she."  She gives up painting and becomes Gerda’s primary model. Gerda’s paintings become highly sought after with her new model.  

Lili’s quest to become a woman intensified over the subsequent years and extended to hoping to acquire a uterus so that she could give birth. With Gerda’s help, Lili eventually finds a surgeon in Germany who is willing to perform a series of risky procedures that will make her into a woman. After the operations, Lili was transformed into the woman she wanted to be, but without the availability of anti-rejection drugs and antibiotics, she died in the hospital with Gerda at her side.

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The Sick Child

Munch, Edvard

Last Updated: Nov-08-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Visual Arts / Painting/Drawing

Genre: Painting

Summary:

Edvard Munch’s painting, The Sick Child, hanging in the Tate in London, England is his fourth version of the painting. This version is done in oil on canvas and was completed in 1907. The first version was painted in 1885.  

As we come upon this painting, we quickly realize we are standing at the end of a bed intruding upon a poignant moment. In this impressionistic painting, we can discern an adolescent girl propped up in bed. She is facing an older woman sitting at her side. We don’t see this woman’s face because her chin is on her chest in a way that makes her look distraught. We can easily conclude that she is the girl’s mother and that the girl is sick, very sick.
 

When we look around the room with the view Munch gives us, we see little in the way of medical supplies or equipment. There is only a bottle on a nightstand that might be some potion and a glass of water on a dresser. Nothing more is to be done for this child. She seems to know it and so she tries to comfort the woman who is attending her. The painting reminds the viewer that often those who are dying offer comfort to the ones attending them as well.

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The People in the Trees

Yanagihara, Hanya

Last Updated: Oct-10-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The novel takes the form of a memoir written from prison. The fictional author is Dr. Norton Perina who was awarded the Nobel Prize in Medicine for discovering what caused some people on a remote Micronesian island to live for up to 250 years or longer. Dr. Ronald Kubodera, Perina’s long-time colleague, convinced him to write the memoir while he was in prison. Perina sent Kubodera a chapter at a time, which he would then “lightly edit” and add occasional footnotes to elaborate on a given section. 

Perina is in prison for being convicted on “two counts of sexual assault,” (p. 349) though we can believe he is guilty of many more counts. All of these transgressions involved children, many of whom were under his care as their adopted father. However, the bulk of the memoir is not about the behavior that lands him in prison. Instead, it tells of Perina’s successful scientific investigations of a hidden people in a secluded partition of an unknown island in Micronesia. He came to this place while stumbling around for a career direction after medical school, and then came to discover the hidden people when stumbling upon one lying on the forest floor.

Perina eventually linked the consumption of the meat of a particular turtle on this island to a prolongation of life measured in hundreds of years. Only the inhabitants who reached around 60 years were given the turtle meat and only during a ceremony to mark the milestone. While the bodies of these people remained as they were physically when they consumed the turtle meat, their minds did not. As they aged they became non compos mentis—“all they could do was jitter and babble and laugh at nothing, the neighing laughter of the brainless.” (p. 95) Perina’s published papers called attention to a possible fountain of youth and produced the expected rush among pharmaceutical companies to distill the turtle’s magic into a pill. All they managed to do instead was to destroy the island’s habitats,
corrupt its people, and hunt the turtles into extinction.
 

Very little is said in Perina’s memoir about any activities leading to his pedophilia conviction until the very end; however, occasional hints that Perina could be a pedophile appear before then. At one point in particular he describes an encounter with a 10-year old boy from the village that might have awakened any such tendencies that had been dormant. Another time he admits “some of the only comfort (and certainly the only amusement) I’d found had been with the village’s children.” (p. 267). During subsequent trips to the island over the next few decades, Perina adopted 43 island children and brought them home to raise as his own. He was drawn to children, but in not so innocent a manner. Only at the very end of book, and only in the postscript, do we get any details about how he preyed upon these children.

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The Father

Zeller, Florian; Hampton, Christopher

Last Updated: Jul-12-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Plays — Secondary Category: Performing Arts / Theater

Genre: Play

Summary:

This annotation is based on a live performance presented by the Manhattan Theater Club at the Samuel J. Friedman Theater  in New York City that ran between April and June of 2016. The play was nominated for a 2016 Tony Award for best play, and Frank Langella won the 2016 Tony Award for best performance by an actor in a leading role in a play. In supporting roles were Kathryn Erbe, Brian Avers, Charles Borland, Hannah Cabell, and Kathleen McNenny.
 
The Father is the story of an older man with Alzheimer’s disease (André) and his progression through first living on his own, then living with his daughter (Anne), and finally living in a nursing home. Or, is it? It’s hard to tell, and that is the intention of the playwright, Florian Zeller, who told The Guardian (2015), “The Father is about an old man lost in the labyrinth of his mind.” The objective of the play is to bring audience members into the actual dementia experience so that rather than witnessing André’s disorientation they feel his disorientation.  

The director, Doug Hughes, creates the audience experience through an interplay among set designs, lighting effects, repeated scene sequences, and time loops as contexts for various symptom manifestations like memory loss, paranoia, anger, and lasciviousness. All the scenes take place in one room that serves at different times as André’s flat, Anne’s flat, and a nursing home room. The furnishings of the room change based on the supposed setting, but the walls are exactly the same for all of them. In different scenes, André is not always sure where he is, and neither is the audience.  

Early in the play, André hears Anne tell him she’s relocating from Paris to London with her lover, but she is present to him in most of the scenes thereafter and until the end of the play when he’s told by a nurse that Anne had moved to London some time ago. Had she really left Paris and was never actually there in all those other scenes? He wonders and so does the audience. In other scenes, the way characters from the past and present enter and exit distorts time for André, and so while audience members know the linear trajectory of the disease course, they can’t be sure of where they are in that course during a given scene. With the last scene taking place in André’s nursing home room with the same walls seen in his flat and Anne’s flat, the audience can’t be faulted for wondering whether all that came before was just one of André’s hallucinations.  

The play does not keep audience members in a perpetual state of confusion and despondency. Farcical elements are peppered throughout that produce occasional laughs, such as when Anne contests André’s account of a previous conversation, he suggests it’s she who has the memory problem: “You’ve forgotten. Listen, Anne, I have a feeling you sometimes suffer from memory loss. You do, I’m telling you. It’s worrying me. Haven’t you noticed?”

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We Are Not Ourselves

Thomas, Matthew

Last Updated: Jun-20-2016
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1951, Eileen Tumulty, the novel’s main character, was nine years old and living with her Irish immigrant parents in the Woodside section of Queens, New York. The novel follows Eileen straight through the next 60 years, but concentrates on the years covering the time of her husband’s Alzheimer’s disease.    

Eileen was forced to learn how to manage a household at a very young age when first her mother was kept in a hospital for 8 months after a hysterectomy, and then again when her mother became incapacitated by alcoholism. Eileen had reason to think this life was her destiny until she accompanied her father to a better part of Queens. There she saw “places…that contained more happiness than ordinary places did.” She concluded, “unless you knew that such places existed, you might be content to stay where you were.” (pp. 15-16) Eileen’s ambition was ignited. While continuing to manage the household and care for her mother, she does well in school, becomes a nurse, and eventually moves up the nursing management at various hospitals.  

Eileen’s ambitions encompassed ideas on her eventual mate. She chooses Ed Leary despite hoping for someone who was not quite so Irish and not quite so much of the same place. Ed was a promising neuroscience graduate student who she thought could be a high achiever with the right motivation: “If there was anything she could help him with, it was thinking big.” (p. 97) Her motivation was not enough and neither were the many offers he received from life science companies. He became a professor at a local community college. He had a passion for teaching students who attend community colleges and he could never see himself anywhere else—for love or money. Ed’s intransigence frustrated Eileen, but she accepted it and plowed ahead. She studied the possible ways of escaping the old neighborhood and also delivered a son she thought she’d never have after years of futile efforts.  

It doesn’t go smoothly. While she is getting surer of where they would go, Ed begins to exhibit disconcerting behaviors. For them to live in Bronxville, Eileen will have to accept a house that needs a lot of money and attention to rehabilitate. The remainder of the story is about how Eileen simultaneously manages Ed’s rapid deterioration from what eventually is diagnosed as Alzheimer’s disease, her job requirements, and a son progressing from adolescence through college.  

We Are Not Ourselves
touches on many of the aspects involved in prolonged illness including the daily struggles managing the care of someone with progressive dementia, complexities of health care delivery systems, frustrations with byzantine health care coverage, and threats to relationships among the individual family members with one another, and the grace that can manifest during the bleakest moments. The author does not dwell on all these issues, but gives them enough attention so that their effects will be recognizable to many readers who have experienced them. In doing so, he was able to draw from his own experiences with his father who was stricken with early onset Alzheimer’s disease.

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