Summary:

Subitled, Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, this monograph features 27 contributing researchers. Published by the RAND Corporation, it is funded by a grant from the Iraq Afghanistan Deployment Impact Fund. The study was conducted under the joint auspices of the Center for Military Health Policy Research, a RAND Health Center, and the Forces and Resources Policy Center of the National Security Research Division of the RAND Corporation.
 
The work deserves our full attention as it delineates and explains the economic, human, medical, political, public health, and social consequences of injuries suffered by returning veterans of US involvement in 8 years of continuous conflict in Afghanistan and Iraq. The introduction defines the three kinds of invisible wounds affecting thousands of the 1.64 million American troops deployed in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) since 2001. These combat related injuries are post traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). Upwards of 26% of returning troops may have mental health concerns, including drug and alcohol dependency, homelessness, and suicide.

The monograph analyses numerous studies of these issues, both governmental and non-governmental, and RAND has conducted its own study. The data collection is recent: from April 2007 to January 2008. RAND estimates that approximately 300.000 persons currently suffer from PTSD or major depression; in addition, 320,000 veterans may have experienced TBI during deployment.

The recommendations include evidence based care at the VA level, the state and community level, and on site in Afghanistan and Iraq. Adequate care would pay for itself and save money in the long run by improving productivity and reducing medical and mortality costs for members of the US armed forces.

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Born in 1921 in Belarus (White Russia), the author lost his father (a doctor) as a baby and was raised by his mother who worked as a surgical nurse and midwife. He excelled in school and was on the verge of entering medical school, but the political upheaval of World War II drew him away from studies.
 
Drafted to serve in the Polish army, the eighteen year-old became a sergeant in charge of a platoon by June 1939 fighting against Germany along its border with Poland. Three months later he was captured and imprisoned in cruel conditions. By November, he escaped and began a long walk home, helped by strangers, only to find that the Soviets had taken over. Arrested again, this time for being anti-Communist, he spent January to June 1941 in a Soviet prison, and narrowly avoided execution when the Russians retreated at the German invasion of Minsk. Another return home was met with the tragic news that his mother had been killed when German bombs hit the hospital in which she worked.

Enraged by the succession of destructive invaders, Ragula helped create a nationalist freedom army, the Eskradon, ironically with German support, and a Bulletin to inform citizens and lobby for better conditions. By the time World War II drew to an end he was married to Ludmila (in 1944) and on the move, seeking a medical education.

As refugees, the couple moved to Marburg, Germany in 1945, where Ragula began medical school. But money was always a problem and the post-war restructuring of Europe made them fearful. Hearing of a program for refugees in Louvain, Boris entered Belgium illegally in 1949 and finally completed his medical degree in 1951 at age thirty-one. In 1954, the couple settled in the medium-sized town of London Ontario, Canada. There Ragula interned and set up a family practice. He and Ludmila raised their family of four in peaceful security that contrasted starkly with their own upbringing.

Precocious in promoting health, Ragula campaigned tirelessly against smoking, inactivity, and overeating, and he worked in aboriginal communities, convinced that a doctor's role was to prevent disease as much as it was to treat it.  Here too he found enemies and friends.
 
In 1963, Ragula was involved in a non-related kidney donation between patients-a selfless act that touched him deeply. For him, it represented the pinnacle of scientific achievement and epitomized how humans should care for one another.

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This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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Triggered in part by a trip to the Galápagos Islands, the author interweaves two parallel narratives: Darwin's "journey toward evolution" along with the related work of Alfred Russel Wallace; and the author's own journey through life, partially disabled and dependent on the specially fitted shoes that help him to walk.  Together these two narratives develop "all I have come to understand about chance and change, fear and transformation, variation and cultural context, ideas about the body that question the definition and existence of difference in all of our lives" (xvii).

Born with an unnamed congenital condition in which his fibulae are absent along with other lower limb "abnormalities," Fries underwent five major reconstructive surgeries as a child, but after those, what helped him most were special shoes that were fitted to his special body, assisting him to walk.  As an adult, however, he begins to experience back pain and knee problems.  The memoir relates, both in flashback, and in the present day, Fries's quest for a proper pair of shoes that will help him avoid yet another surgery -- the shoes he has been wearing are 20 years old and no longer do the job.  We meet Dr. Mendotti, who treated him like a peculiar specimen and offered a pharmacologic way out of his pain; shoemaker Eneslow, in a dingy Union Square office, whose shoes not only fit Fries well, but were festive in appearance -- "I felt both normal and special" (17); other practitioners of orthotics who try but fail to construct shoes that relieve Fries's pain, and finally, the gifted, patient orthoticist, Tom Coburn, who persists until he is able to provide shoes that work.  The shoes have been adapted for Fries's body, just as man has constructed adaptations that allow him to live in a variety of climates and circumstances.  Conversely, Fries, convinced he "can adapt to the circumstances in which my body places me (169)," draws from Darwin, whom he quotes: "individual differences are highly important for us, as they afford materials for natural selection to accumulate" (169).
 
Darwinian connections are invoked throughout the narrative.  The peculiar configuration of Fries's feet and shoes help him to ascend a series of mountain ladders while his partner, Ian -- who usually has to assist Fries with such physical maneuvers -- suddenly becomes fearful of the height and exposure;  back problems might have developed even without his congenital abnormalities because evolution of the capacity to walk upright included the tendency toward back pain; the role of chance in natural selection and the role of chance in the physical fact of congenital conditions; the positive role that his partner Ian's attention deficit disorder (ADD) could have played in the days of hunter-gatherers and the cultural context in which ADD is now considered to be "abnormal."
 
Fries discusses his fears -- both rational and irrational -- as well as his awareness of stigma, difference, and sameness.  The context of these discussions is usually a reminiscence about vacations in far-flung countries (Thailand, the Galápagos, Bali, Alaska, the Canadian Rockies) and physically challenging domestic locales (a Colorado River raft trip, the Beehive Mountain in Acadia National Park).  He  occasionally brings into the discussion his homosexuality, especially as his physical deformity affected sexual encounters.  The relationship between Fries and Ian is woven throughout the memoir as one of understanding, mutual need and benefit.  As the memoir ends, Fries worries about the likelihood he will need a wheelchair, but is at the same time gathering confidence in his ability to ride the Easy Flyer bicycle that Ian has discovered at the local bike shop.

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John Romulus (also known as Richard) Brinkley was a physician (in the diploma-mill sense of the word) who, in 1917, pioneered, in the U.S. at least, the notion of goat testicle transplant. "Transplant" must be understood in the loosest sense of the word since Brinkley simply removed the testicles from young goats and sewed them into the abdominal wall and scrotal tissues - without any attempt to connect blood or nervous tissues of either goat testicles or human  - of men for the alleged purpose of relieving impotence. From 1917 until his downfall at the hands of Morris Fishbein, a medical crusader esconced in the AMA, which organization Dr. Fishbein helped establish as the premier advocate of organized medicine in the U.S., Dr. Brinkley was perhaps the most recognizable physician in the U.S.

He ran for the office of Governor of Kansas in 1930 (losing by technicalities that today would have overturned the results), and established the most powerful radio station in the land, XERA, that promulgated his glandular chicanery all across the continental U.S. As a proponent of such skullduggery, Brinkley was continually in the sights of Dr. Fishbein, whose main reputation nationally was as an exposer of medical fakery. Eventually Fishbein lured Brinkley into a libel trial that resulted, in 1939, in the catastrophic downfall of an immensely talented and wealthy man who spiraled into bankruptcy and death in 3 short years.

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As the film opens, Joe Buck (Jon Voight) is exuberantly preparing to leave his run-down Texas hometown to head for New York City. He has outfitted himself as a spiffy cowboy, intending to "hustle" wealthy New York women who will beg for his sexual favors, and pay him in the bargain. As he interacts with the bus passengers during the long journey to the Big City, we see that underneath the bravado, Joe is anxious for friendship and haunted by memories of a lonely childhood. Abandoned by his mother (a father is never in the picture), Joe was raised by his grandmother, who spoiled him, yet neglected him, and whose assorted boyfriends competed with him for her attention.

In New York, Joe is naive and out of place. His attempts to hustle women are rebuffed or backfire ludicrously--he ends up paying them. In a Times Square bar, he runs into a crippled con-man, "Ratso" Rizzo (Dustin Hoffman), who offers to be his "manager" but steals his money in a scam. As his funds run out, Joe resorts to selling himself in a homosexual encounter; even this backfires--he picks up a student who has no money.

As Joe is becoming quite desperate--homeless, with only his portable radio for company--he runs into Ratso again. Partly to make amends, and partly out of his own loneliness, Ratso invites Joe to his "home," a room in an abandoned building, without electricity or heat. Warily at first, and then with increasing mutual respect, the two set up housekeeping. Theirs is a daily struggle for survival--petty thievery, selling blood, and fantasies of a gigolo's life in warm Miami sustain them.

In the heatless apartment Ratso's health deteriorates--he has a chronic cough, smokes constantly, and the weather is frigid. Underground movie-makers choose them as street curiosities for the camera, inviting them to an avant-garde party replete with food, drugs, and a rich woman (Brenda Vacarro), who takes Joe into her bed and pays him for it, arranging another "transaction" later in the week for a woman friend.

Joe thinks he has finally made it. Ratso, however, has a high fever, can no longer walk, and refuses medical attention. Joe makes the choice: he assaults and steals for the busfare to take Ratso to Miami. During the trip Joe tells Ratso, "I'm going to get some sort of job--outdoor work--I'm no hustler." But Ratso, seated next to him, has died. Joe puts his arm around the dead man, protecting him from the curious stares of the other passengers.

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The poem begins, "Somebody who should have been born / is gone" and this phrase is a refrain intercalated between two sets of three tercets, with a final closing tercet. Each tercet has a rhyme scheme of a, b, a. The speaker narrates a journey that takes her south to an abortionist in the mountains of Pennsylvania, and then, after the abortion, back home to the north. The situation and the speaker's perception of it are rendered in metaphors that draw on the natural environment through which the journey proceeds. At the beginning, the earth puffs buds, and the drive proceeds toward blue-green mountains -- metaphors of fecundity. The description of the mountains as "humps" might imply the sex act that initiated pregnancy.

Soon, however, there is foreboding as dark images of tearing and splitting appear: "the ground cracks evilly," "and me wondering how anything fragile survives." Then "a little man . . . took the fullness that love began" and the speaker returns north, physically and emotionally reduced as the sky grows thin and the road is "flat as a sheet of tin."

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Dora Rare, the only girl child born in multiple generations of her family is encouraged by her mother to establish a bond with Miss Babineau, an odd isolated midwife, whose wisdom on health matters is much sought after by the local women in their small Nova Scotia community. Gripping and intimate encounters with her neighbours as birthing mothers and as women seeking control over their fertility lead Dora to accept a role as Marie’s successor. When arrogant, young Dr Gilbert Thomas comes to town with his strong ideas about science and birth, he is appalled at the practices of the local women; he also resents the competition. Dora embarks on a difficult marriage herself and seeks temporary refuge in the United States where she witnesses a new kind of independence.

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Little-and yet everything- is left to the imagination in Douglas Gorsline's Bar Scene. Seated at a crowded urban bar is a young woman. She is almost elegant in her silk blouse, fur coat and broad-brimmed black hat. Though she sits with her shoulders parallel to the picture plane, and has been placed squarely in the middle of the foreground, her thoughts-and her gaze-are clearly directed elsewhere. Standing behind her, is an older man. As he tips his head back to drink, he, too, is looking off to his left, but with eyes that are conspicuously narrowed. The lengthening ash on his cigarette suggests that his left hand has not recently moved from the woman's shoulder.

Where the smoldering cigarette gives a clue about time lapsed between the two figures in their current position in the painting, the woman's rumpled neckline invites the viewer to imagine what has transpired between the two of them in the time before they came to be seated at the bar. The woman's open blouse is bunched and gaping at her waistline as if mis-buttoned. The pointed blouse collar that is smoothed on top of her fur coat on her right, is tucked beneath on the left side. The man's shirt is also wrinkled, possibly unbuttoned behind the tie, and not tidily tucked in at the belt-line.

This foreground scene is connected with the rest of room by the line of smoke rising from the cigarette and the curve of the bar, along which are seated several single men and another couple. The setting has been recently identified as Costello's, a popular New York City bar that was well-known to the painter.[1] Though the figures themselves are not specific, the attention to the details of the space and the clothing are, suggesting that the moment Gorsline has captured was a moment observed. The painting is dated in the lower right-hand corner: 1942, a complicated period in American and world history. Although it does not take a world at war to foster relationships that are at once intimate and distant, the war certainly complicated many relationships between women and men.

[1] Marie Via, "Douglas Warner Gorsline Bar Scene [1942], " In: Marjorie Searl, ed. Seeing America: Painting and Sculpture from the Collection of the Memorial Art Gallery of the University of Rochester (Rochester, NY: Memorial Art Gallery) 2006, pp. 249-253.

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Nan Cohen's poem, Rope Bridge, from the collection of the same name, explores the intersections between science and art by lyrically describing a landmark psychological study on the attribution of emotion. The study, by Dutton and Aron in 1974, was based on the theories of Schacter and Singer from the previous decade. In one set of experiments, male volunteer subjects met a female assistant under two different circumstances - either in a benign setting or after braving the swaying Capilano Bridge. This bridge is suspended hundreds of feet above a river near Vancouver, British Columbia, Canada; subjects who met the assistant after crossing the suspension bridge were more likely to exhibit behaviors compatible with feelings of attraction to the woman.

The brilliance of Cohen's poem is the smooth interplay between scientific and poetic language. Imbedded in the poem are survey questions with lines ready for tick marks, as well as phrases such as "the attribution of a heightened state". The scientific language is not only juxtaposed, but intertwined with lyric flights: "Who would say: it is fear that takes my breath, / that wets my palms... / the fear that sleeps in me".

 

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