Showing 81 - 90 of 195 annotations tagged with the keyword "Psycho-social Medicine"

Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In Dirty Details, Marion Deutsche Cohen writes about the unrelenting labor entailed in caring for her husband Jeffrey at home as multiple sclerosis turns his symptoms from "mere inconveniences" (11) to extraordinary demands, which can disturb her sleep as frequently as twenty times a night.  The premise of her unsparing narrative is that "we have got to spill the dirty details" (26) of such arrangements before the endurance-draining responsibilities of home care such as hers can be understood and redressed.  In a culture that favors narratives of seemingly heroic individual effort, Cohen's brutally forthright descriptions of the effects of Jeff's needs on her life can be mistaken for a self-pitying complaint, rather than an urgent, revelatory, political call to action.  Like her husband, a well-published physicist at the University of Pennsylvania when diagnosed with MS at age 36 in 1977, Cohen is an accomplished professional.  With a PhD in mathematics, Cohen teaches college students as well as publishes poetry and prose.  She and her husband also shared, with increasing asymmetry, the parenting of their four children.                 

Cohen captures the wearying routine of her days in her narrative's echoing refrain, "nights, lifting, and toilet."   The nights refer to Cohen's dangerously disrupted sleep.  Her husband's respirator can sound every half hour or so, inciting her to worry "about the psychological effects of seldom being allowed to finish my dreams" (23).  (When she asks if the machine can be fixed, she's told that it's supposed to behave that way.  By implication, so is she, despite the toll on her well-being.)  Yet she daily rallies the strength to lift her husband on and off the toilet, a feat, among others, that sometimes defied the powers of several hospital nurses working together.   Toilet also means responding to Jeffrey's regular calls to her to drop what she's doing, run upstairs, and bring him a jar.  The jar at least relieves her from lifting.  She experiences only intermittent relief, however, from finding and keeping home health aides who are able to show up reliably and behave civilly during the few hours per day they can be funded.  What results from these tests of human stamina, Cohen tells us, is not "ordinary stress" that some optimistically believe can be managed by taking stress reduction workshops, but rather "dire straits."  "Calling dire straits stress," she corrects, "undermines well spouses and makes us feel alienated and confused about where we stand" (32). 

It's that standing in the broadest sense of the word that Cohen's book most searingly addresses.  While Dirty Details contains one woman's account of caring for a disabled husband at home, the book's wider purpose is to make the labor of family caregivers visible with all its strains, conflicts, messiness, failures, anger, and, at times, humor.   As the straights become increasingly dire, though, Cohen writes about what happens to love as she moves from sustaining tenderness, candor, and their physical intimacy to diminishing her compassion for Jeff and saving herself:  a "pure survival instinct" (87).   After sixteen years in his family's care, Jeff at first reluctantly enters Inglis House, a residence that provides as much independence as possible for those who cannot live independently, where he continues to write and publish.  Cohen's professional life, social life, and beloved parenting once again flourish.  The story she is freed to write (illustrated with photographs by Anna Moon taken with Jeff's consent) lead readers away from her particular circumstances toward a comprehensive interrogation of social and medical systems that operate by leaving the most chronically ill and disabled citizens in their families' care by default.   And leave the families in dire straits.

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Summary:

One day in the 1920’s, a newspaper reporter walked into the laboratory of Russian psychologist A. R. Luria and asked him to test his memory, which he recently had been told was unusual. It was not unusual. It was uniquely and astoundingly retentive. Luria gave him very long strings of numbers, words, nonsense syllables and could not detect any limit to his ability to recall them, generally without mistake, even years later. (Luria studied S., as he identifies him, for thirty years.)

Luria discovers that the man had some interesting characteristics to his memory. He experienced synesthesia, i.e., the blending of sensations: a voice was a "crumbly, yellow voice." (p.24) S.’s memory was highly eidetic, i.e., visual, a characteristic not unique to him but which he used as a technique to memorize lists and details. (He had become a performing mnemonist.) It was also auditory. He had trouble remembering a word if its sound did not fit its meaning. The remainder of the section on his memory involves fascinating aspects of his having to learn how to forget and his methods of problem solving.

The remainder of the book is equally interesting since it relates the epiphenomena of S.’s prodigious memory: how he mentally saw everything in his past memory; how he was virtually paralyzed when it came to understanding poetry since metaphorical thinking was almost impossible for him, a mnemonist who lived in a world of unique particulars! As Luria wrote, "S. found that when he tried to read poetry the obstacles to his understanding were overwhelming: each expression gave rise to an image; this, in turn, would conflict with another image that had been evoked." (p. 120)

S. could control his vital signs by his memory and, last but not least, this human experiment of nature had such a vivid imagination that, probably more than the most creative of us, he engaged in "magical thinking": "To me there’s no great difference between the things I imagine and what exists in reality. Often, if I imagine something is going to happen, it does. Take the time I began arguing with a friend that the cashier in the store was sure to give me too much change. I imagined it to myself in detail, and she actually did give me too much--change of 20 rubles instead of 10. Of course I realize it’s just chance, coincidence, but deep down I also think it’s because I saw it that way." (p. 146)

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The Ninth Life of Louis Drax

Jensen, Liz

Last Updated: Nov-19-2009
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Louis Drax is a nine-year-old boy living in France with his stay at home mother and Air France pilot father. Such an apparently normal family description is the merest tissue of appearances. The father is probably an alcoholic and unfaithful; the son is "accident-prone" (a nearly fatal episode of SIDS at two weeks of age, a near fatal electrocution at age 6 after falling on the tracks of the métro in Lyon; salmonella, tetanus, botulism, meningitis, etc. [or, as Louis is fond of saying, "blah, blah, blah."]) and the mother has issues that only emerge as one becomes more deeply involved in what is a mystery story.

Like Gabriel Garcia Marquez’s A Chronicle of a Death Foretold, or Janet Lewis’s superb The Trial of Søren Qvist, one knows the ending early on (page 16 in Louis Drax), but not the details. The why and the how are the stuff of the novelist’s art in all three books.

With premonition of more danger, Louis goes on a family picnic (see below for the author’s biographical basis for this tale) and winds up at the bottom of a ravine, dead. Drowned and dead. A few hours later, in the morgue, he is found to be alive. Comatose and in a persistent vegetative state but alive. He is therefore transferred to the care of a neurologist specializing in comatose patients at the Clinique de l’Horizon (formerly l’Hôpital des Incurables).

It is here that the mystery unfolds. The questions are: How did Louis end up at the bottom of the ravine? Did his father, now missing, push him as his distraught mother alleges? What role does the clearly neurotic mother play in this tragedy? And who exactly is Louis Drax? Lastly, how do the mysterious letters allegedly from him, written while still in a coma, come to be?

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Poets on Prozac contains sixteen essays written by poets about their individual struggles with a variety of psychiatric disorders. The editor, physician and poet Richard Berlin, has gathered these essays in order to examine, and shatter, the long-standing notion that madness, particularly madness in poets, enhances creativity---we need only think of the myths surrounding writers such as Sylvia Plath and Dylan Thomas to understand how the relationship between madness and creativity might foster both fear and longing in novice writers.

In his informative and comprehensive introduction, Berlin poses these, and other, questions: "Do poets need to be mentally ill to produce great work? What is the influence of substance use/abuse? Does a person have to be 'crazy' to write good poetry? What do poets themselves define as crucial elements in their creative process?" (p. 2). He goes on to site current evidence that madness actually impedes creativity, as well as evidence that "some forms of mental illness may enhance, or at least coexist, with creativity" (pp. 4-5); he reviews the findings of researchers who have looked at "The Myth of Inspiration" and "The Myth of Very Special Talent" in creative persons (pp 6-7).

But it is in the wonderful essays themselves that we take a privileged peek into the lives, the often tortured lives, of successful poets (Berlin only considered the essays of poets who had published at least one book). Reading the essays is somewhat like eavesdropping on the therapy sessions of highly articulate and self-aware patients. Clearly Berlin has created a safe place for these writers to look again at their creative lives and how those lives intertwine with, and sometimes have been overgrown by, mental illness. All the essays, happily, come to a place of resolution; the writers find, in various degrees, that understanding or relieving their emotional distress results in the possibility of increased creativity. Along the way, they give us writing alive with metaphors, images and intelligent musings on art, poetry, life and suffering.

In the first essay, "Dark Gifts," Gwyneth Lewis writes about her depression: "I became Woman in a Dressing Gown. At my worst, the duvet on my bed looked like a body bag and I was the corpse inside it" (p. 13). Finally she concludes, "I've learned that depression is one of the most reliable guardians of my life as a poet. It's like a fuse in a house with suspect wiring" (p. 22). In his essay, Andrew Hudgins describes cortisone psychosis this way: "I was a fire station in which the alarm bells seldom stopped clanging and the firemen were exhausted and indifferent" (p. 163). In "The Desire to Think Clearly," J. D. Smith says, "Being a poet in despair does not necessarily make one a poet of despair" (p. 23). As most of the poets do, Denise Duhamel uses examples of poems within her essay to demonstrate how her illness, in this case bulimia, variously inhibited or influenced her writing. The rawness of illness shows up, again and again, in her ability to be brave and resolute in her poems: "I'm still working it out, as they say, as therapists say, as my friends say, / as I guess I'm saying now in this poem" (p. 37).

Many of the poets approach their illness histories with wry humor or pointed irony. Caterina Eppolito states that "Poetic form is an anorexic form of writing. So instead of restricting calories, I was restricting words" (p. 118). Ren Powell asks, "Maybe when it's all over I can ask my children if they think the days of dancing in the kitchen were worth the days I spent shut away in the bedroom" (p. 52). Powell, like most of the authors in this anthology, honors hard work at the craft as the measure of success, and says, "If I have any success at all as a writer it is as much despite my disorder as because of it" (p. 57). Other writers admit wondering, sometimes, if their writing success might be due to their disorders. Jesse Millner writes, "After all, wasn't it the melancholy that led me to write?" (p. 67). Most writers agree that abusing substances did not enhance but sidetracked their poetic energies, while prescribed medications often, as Jack Coulehan says, helped: "The obsessive traits softened, so I felt free to approach life in a more flexible manner. Despite this new experience of freedom, my productivity did not suffer; in fact, it increased" (p. 101).

The chemical basis for some mental disorders is acknowledged in many of the essays. In her discussion of postpartum depression, Martha Silano notes, "I'd simply woken up in a foreign country without a map, without a dictionary, with no way to understand this strange place" (p. 142). Silano, like others in this collection, found that once the chemical imbalance was corrected, something good happened to the writing---she moved from writing about her own personal experience to writing that reached beyond her fears: "Now I was writing poems with a more universal, all-encompassing vision" (p. 146). Liza Porter says it this way: "Voice comes from safety. Silence becomes words. The truth can be told" (p. 153). But the downside of medication is admitted as well. Chase Twitchell laments the loss of "metaphor-making," and compares it---in quite a fine metaphor---to someone turning "off the spigot" (p. 176). "It takes longer and requires far more doggedness than it did before medications" (p. 176). But medications also give many of these poets what Vanessa Haley names "the emotional insight and stamina to write" (p. 76). If these excellent essays are any indication, they are, and will continue to be, writing extraordinarily well.

 

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Annotated by:
Mathiasen, Helle

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

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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Summary:

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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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

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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Annotated by:
Aull, Felice

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

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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