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Summary:

This volume belongs in the category of cross-cultural studies of medicine and the humanities. Its main audience is scholars of nineteenth-century American psychiatry and culture. The author divides his study into six chapters, each with a topic, including the simultaneous emergence of nineteenth-century public debate about improving the treatment of insanity and the movement to abolish slavery; cultural activities in asylums directed toward humanizing the patients; bardolatry in British and American medical circles; discussions of Emerson, Hawthorne, Poe, and Melville in the context of their literary and personal relationship with madness; a chapter on captivity narratives and popular novels by former female and male patients; and an epilogue.

Unlike today, "In mid-nineteenth-century America, the condition of the mentally ill seemed to demand-and to a large degree received-national attention and the full creative energy of a group of dedicated reformers" (p. 2). Reformers linked the emancipation of slaves with curing the delusions of the insane. Slaves and the mentally ill had in common deprivation of their civil liberties; however, the difference was that white mental patients could be expected to grow up eventually, whereas black slaves would always remain children, and hence could not be trusted with the right to vote, own property, or sign contracts.Some causes of insanity were deemed to be the individual's reaction to the stress of modern life, too much freedom and choice, religious fervor, masturbation, or excessive study. In their aggressive attempts to remake patients into proper gentlemen and ladies, the new asylums promoted cultural activities such as reading selected texts, theater performances and writing.

Most asylums housed males and females in approximately equal numbers; cultural activities for females stressed piety, fashion, and domestic activity while men could comment on politics, the temperance movement, and opposition to women's rights. Reiss refers to the French model of using cultural activities in asylums, f.ex., Philippe Pinel's staging of plays to educate patients, and Marquis de Sade's theater performances at Charenton. He ends with a discussion of patient narratives that depict some horrific abuses tolerated in nineteenth-century asylums; the degree of these abuses is familiar to us from One Flew Over the Cuckoo's Nest (see film annotation).

The work includes a few illustrations, the most important being an engraving from a painting by Tony Robert-Fleury titled: Pinel Freeing the Insane (1876). (Yale University). Philippe Pinel (1745-1826) was a French pioneer in the humane treatment of mentally ill patients. A Director of Bicêtre Hospital in Paris, he is depicted as a heroic physician, liberating, mostly female, patients there. However, scholars have shown that only 10 of the 270 patients were chained, and that Pinel '"accepted the traditional use of chains to restrain the violent insane as a matter of course"' (p. 160). Reiss's point is that the revolutionary nature of Pinel's treatment of the insane has been exaggerated.

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Words Like Fate and Pain

Fiser, Karen

Last Updated: Nov-19-2009
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This volume is divided into four parts, each containing powerful and fairly short poems--rarely longer than one page and often less than 30 lines--that share the author's experience of disability. The four sections unfold the struggle of coming-to-terms with disability organically, beginning with the body and concluding with the will to survive and transcend the physical.

Section One considers the role of fate or luck (The Short Song of What Befalls--see this database, "Words Like Fate and Pain"), the burden of chronic pain ("Night Shift," Pointing to the Place of the Pain--see this database, "Slow Freight"), the desire to escape physical limitations ("Not Down Here," "What Comes Next"), and the difficulty of adjusting to an altered self image ("What Happened to You?" "Protect Yourself From This").

The sections that follow offer poems that attempt to understand disability intellectually and viscerally ("Levels of Being," "Loving the Clay,"), to look beyond the suffering self to the suffering of others ("Beginning to Write," "The Word 'Class' Should Not Appear in the Poem"), and finally to love and accept what's given ("What Keeps Me Here," "Dreaming the Tree of Life").

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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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Annotated by:
Jones, Therese

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The 2005 documentary film, The Devil and Daniel Johnston, tells the story of Daniel Johnston, a mentally ill artist whose drawings have been exhibited and sold worldwide; whose music has been recorded by Beck, Wilco, Nirvana, Sonic Youth, and Pearl Jam; and whose fans include the actor, Johnny Depp and Simpsons creator, Matt Groening.  Diagnosed with manic depression complicated by delusions of grandeur, Daniel has spent the last three decades of his life in and out of mental hospitals.  His wild fluctuations, downward spirals, and periodic respites are chronicled in the film through compelling interviews, home movies, recorded tapes, and performance footage.  The title is an allusion to Johnston's intense Christian beliefs and his spiritual war with Satan.   

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Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This chapbook of 26 poems traces the author's interactions with her mother, a woman lost in the morass of Alzheimer's disease. In the first poem, "The Loss" (1), the author takes us into her mother's home--a disorganized mess of stained thrift shop clothes folded and refolded into piles. The daughter tricks her mother into moving in with her "for a trial" which becomes permanent.

In the last poem, "At Least This" (26), the poet stoops "to pull the diaper / up around my mother's / waist, my temple / near her breasts." As the daughter leans into this task, the mother caresses her hair, embraces her. This hug, beautifully and simply portrayed, is the poet's fragile reward for all the struggles, mercies and difficult moments examined in the poems between.

These poems are both beautiful and unfailingly honest, addressing with humor and charity the difficulties of caring for a parent with this disease. In one poem, "The Battle" (5), the mother slathers herself with Vaseline. In another poem, "The Bath" (7), the mother lies in the bathtub, her flaccid skin smoothed by water's illusion, her body suddenly as lovely as Bonnard's painting of a woman bathing. "This is the mother I battled / when young: the mother / who beat my defiance; / the one I hit back," the poet writes in "A Late Blessing" (6), and in another poem, "Intellectual Opiate" (10), she speaks of her mother's love for words she no longer understands.

But these poems are more than poignant narratives about a daughter's relationship with a once-difficult, now dependent mother. They address the "seeds of her disease" (11), exposing the flaws of this relationship without dishonor or blame. In these poems, Slatkin's mother appears vibrant and whole, not ravaged by disease. Rarely have the difficulties and possibilities of Alzheimer's disease been presented in poetry with such insight and respect.

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Annotated by:
Davis, Cortney

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In 1997, the author’s 14-year-old son, Ike, began a puzzling, progressive degenerative illness. Slowly, this undiagnosed disease claimed Ike’s ability to walk, to study, to participate in normal adolescent activities and, finally, to reason. Going from physician to physician, seeking if not a cure than at least a working diagnosis, the author became a self-taught expert in all things neurological.

As her son’s condition worsened, she also became an expert in grief and despair. In Blue Peninsula, her first book, McKeithen relates how she became, as well, a poetry addict--reading, devouring, tearing poems out of journals, buying volumes that she could carry to office or hospital, hiding poems in her purse or pocket. Using poems or pieces of poems--sometimes she could not bear to read a final stanza, one that perhaps ended in death or unrelenting despair--she cobbled together a survival plan.

Indeed, in this small book of short, to-the-point chapters (with titles such as "Crying in the Car," Open to It," Acquiring Losses," Sifting Questions," "Naming," "Shipwreck," and "Shelving Selves"), she reveals how she used poems to grieve, to question, to celebrate, to maintain, to curse, and to endure. The story of Ike’s illness, treatment and slow decline are interwoven with these poems and the author’s often surprising commentary on how she mined the poet’s metaphors. If a poem could put suffering into words, the author suggests, she needed that poem to survive.

The author’s choice of poems and poets is far-reaching, and her interpretations of what they mean and how they helped her along the path of her son’s illness are intimate, gritty and insightful. A brief listing of poets includes Emily Dickinson (whose poem "Blue Peninsula" supplied the book’s title), Billy Collins, Elizabeth Bishop, Diane Ackerman, Zbiginew Herbert, The Rolling Stones, Paul Celan, Molly Peacock, David Whyte and many others, known and lesser known.

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The Line of Beauty

Hollinghurst, Alan

Last Updated: Nov-19-2009
Annotated by:
Henderson, Schuyler

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Hollinghurst's Booker Prize winning novel begins in 1983, just as Nick Guest has graduated from university. A young middle class gay man, he has secured for himself a rather cozy spot in the posh Notting Hill mansion of the wealthy Fedden family, based on his friendship at Oxford with the family scion, Toby, and partly earning his keep by looking after the daughter, Catherine, whose manic depression is marked by mood swings, lability, suicidal thoughts, and self-mutilation.

Gerald Fedden, the imposing paterfamilias has recently been elected a Tory MP (Member of Parliament), rising to power on the coattails of Margaret Thatcher's dominance of British politics in the 1980s. The story follows Nick through the mid-1980s, between Thatcher's two re-elections, chronicling his relationships with the Fedden family, his parents and his lovers, as his own fortunes and opportunities swell and then burst.

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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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Sea of Glass

Farrington, Carolyn

Last Updated: Nov-19-2009
Annotated by:
Davis, Cortney

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This short novel tells the story of Renee and Michael Talbott and their son Evan, a young man "admitted to the hospital as a voluntary patient when he was no longer able to survive in the outside world." Evan's schizophrenia and recurrent institutionalizations, described from his mother's point of view, devastate his family and drive a wedge of guilt and resentment between his mother and step father.

The novel, although written in simple, straight-forward prose, suggests a Dickens-like expose' of social ills, human entanglement, and (perceived) medical mistakes. At the book's conclusion, Renee, sensitized to the fate of all who suffer from mental illness, finds no resolution even when Evan is, for a time, stable and independent.

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The Echo Maker

Powers, Richard

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

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Mark Schluter, a 27 year old beef-processing plant worker, becomes involved in a car crash outside Kearney, Nebraska, the locus of this novel. The car crash---on February 2, 2002, a date that the author wishes to impress the reader as one that seems too numerically mystical (02/02/02) to be co-incidental--clearly has mysterious elements about it since it occurred far outside town on desolate flat country roads and amidst the tire tracks of another car. Too, just after Mark is hospitalized, there appears an undecipherable note of anonymous provenance:

I am No One
but Tonight on North Line Road
GOD led me to you
so You could Live
and bring back someone else.

Mark has an initially troublesome route to recovery, including a temporary ventriculostomy to relieve the pressure in his head. Meanwhile his only sibling, Karin, 31, rushes to his side from Sioux City, a move that becomes permanent and costs her her job. Mark eventually awakens but with an unusual mis-identification syndrome, called the Capgras syndrome (more commonly encountered in patients with psychiatric condition), in which the patient fails to recognize those closest to him as such. For a Capgras patient, there is a disconnect between the visual ability to recognize their faces and emotional response to them as close relatives or friends. He recognizes the visual similarity but considers the significant other an impostor.

This rupture in the usual see-sister's-face-acknowledge-as-sister apparently occurs, in the Capgras syndrome, in connections between one's "primitive" or "reptilian" brain, including the amygdala, and the cortex. Much is made of this failure of neuronal circuits to connect, and reminds one of the parable in His Brother's Keeper (see database) about the Chinese Emperor and the failure of the transmission of a message to explain the pathophysiology of amyotrophic lateral sclerosis. As Karin remembers the neurologic explanation, " 'His amygdala, she remembered. His amygdala can't talk with his cortex" [original italics] (80). This amygdala-cortex dichotomy becomes, in behavioral terms, feeling versus reason. As discussed by the two neurologists involved in Mark's case, "But no emotional ratification. Getting all the associations for a face without that gut feeling of familiarity. Pushed to a choice, cortex has to defer to amygdala"; "So it's not what you think you feel that wins out, it's what you feel you think" (131).

Out of desperation, Karin emails a request to Gerald Weber, a famous cognitive neurologist-author modeled primarily after Oliver Sacks but with a little A. R. Luria, whose "To find the soul it is necessary to lose it" is the epigraph of the novel. From the time Weber meets Mark and Karin, the book becomes an intricately entangled design of various metaphysical threads all of which, directly or indirectly, revolve around Mark's syndrome and identity--in fact the identity of all the characters. Karin becomes involved-- re-involved-- with two men from her earlier days in Kearney, Robert Karsh, a developer, and Daniel Riegel, a conservationist. Later the two men become ideologically more opposed than ever when Karsh tries to develop the annual nesting grounds of the cranes, Grus canadensis, who return to Kearney, thousands of them, every February. Barbara Gillespie, a guardian angel to Mark at the extended care rehab center, and Gerald Weber, until then a man happily married to a prototypically liberal intellectual woman, Sylvie Bolan, become romantically drawn to each other. Weber's own doubts about his work and his public image after unprecedentedly critical reviews of his latest book torment him and lead to concerns about his own identity as a physician who may be using, rather than trying to understand, his patients.

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