Summary:

The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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Summary:

In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.

Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.

Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?

Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).

In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.

Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.

He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.

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Summary:

This is the second anthology from Donley and Buckley derived after many years of teaching "What's Normal?"--a literature and medicine course at Hiram College where they explore the cultural and contextual influences upon the concept of normality. With the first anthology, The Tyranny of the Normal, the editors focused on physical abnormalities (see this database for annotation). In this second anthology, the focus is exclusively on mental and behavioral deviations from societal norms. With this edition, Donley and Buckley present their case that, as with physical abnormalities, there is a similar tyranny of the normal that "dominates those who do not fit within the culture's norms for mental ability, mental health and acceptable behavior (xi)".

The anthology is divided into two parts. Part I is a collection of essays that introduce various clinical and bioethical perspectives on the subject of mental illness. These essays bring philosophic and analytic voices to the topic. Stephen Jay Gould's terrific essay on Carrie Buck and the "eugenic" movement in the United States in the early part of the 20th century illustrates one of the major themes that can be found throughout the anthology.

Oliver Wendell Holmes wrote the majority opinion in the 8-1 Supreme Court decision that sealed Buck's fate. Gould begins his essay reminding his readers of the often referenced Holmes quote, "three generations of imbeciles are enough." He then takes us on a fascinating historical adventure that uncovers a deeper and more complicated drama that led to this unfortunate period in American history, and the tragic incarceration and sterilization of Carrie Buck.

This essay, as with other stories, poems, and drama in the anthology, contemplates the relationship between societal values and mental illness, and illustrates how society through medicine can turn to the myth of "objective" diagnostic labels as a way to compartmentalize and control behavior and imaginations that are "abnormal." D. L. Rosenhan's essay from "On Being Sane in Insane Places" further illustrates the failure of the mental illness label. Irvin Yalom's story from Love's Executioner and Other Tales of Psychotherapy provides an example of what is possible when diagnostic labels are avoided, when health care professionals with power turn with humility, curiosity, and kindness toward others, substantiating that these qualities are far more powerful than statistical notions of "normal."

Part II is a collection of fiction, poetry and drama. Intended as a complement to part I, part II engages the reader in the lived experience of the narrators. It is divided into six sections. Section one considers children and adolescent experience of mental illness. Included are Conrad Aiken's "Silent Snow, Secret Snow," an excerpt from Susanna Kaysen's Girl, Interrupted (see annotation in this database), and an excerpt from Peter Shaffer's Equus (see annotation).

Section two includes stories that capture the world of mental disability and retardation. An excerpt from Of Mice and Men and Eudora Welty's short story Lilly Daw and the Three Ladies are included. Charlotte Perkins Gilman's The Yellow Wallpaper (annotated by Felice Aull; also annotated by Jack Coulehan) is in section three where women's experiences with mental disorders is the theme (these are annotated in this database).

Section four and five focus on men and mental illness. War experience is considered in the works of Toni Morrison and Virginia Woolf. Section six concludes the anthology. Alzheimer's disease and dementia are examined in Robert Davis's My Journey into Alzheimer's Disease, and in the story, "A Wonderful Party" by Jean Wood.

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Summary:

Carl Elliott and John Lantos have brought together a collection of 12 essays that explore the complex work and person of Walker Percy. Personal reflections and stories capture the importance of Walker Percy in the lives and work of several of the essayists, while others offer commentaries on various aspects of Percy's life and work. All of the contributors reveal their affection and appreciation of Walker Percy as physician, novelist, and philosopher.

In addition to the editors, the contributors include Robert Coles, who was Percy's friend; Ross McElwee, the documentary filmmaker; Jay Tolson, Percy's biographer; author and historian Bertram Wyatt-Brown; scholars Martha Montello and Laurie Zoloth; and physicians Brock Eide, Richard Martinez, and David Schiedermayer.

The collection covers many topics and themes. Percy's biography is reviewed: the early losses of his father and grandfather by suicide, the early death of his mother, his medical education and subsequent struggle with tuberculosis, his turn from medicine to philosophy and literature, his marriage and conversion to Catholicism, and his long and productive life as a philosophic novelist.

The essays explore Percy as both physician and patient, and how, as diagnostic novelist, he gives us characters and stories that caution about the technologic-scientific worldview that dominates not only medicine but western life. The many wayfarers are discussed, including Binx Bolling from The Moviegoer, Will Barrett from The Last Gentleman, and Dr. Tom Moore from Love in the Ruins and The Thanatos Syndrome. [These novels have been annotated in this database.]

Percy's spiritual and religious views are reviewed, along with his moral concerns about a post-modern world before anyone had coined the term. The problems of isolation, alienation, and struggle for meaning are apparent in all of his works, and many of the essayists explore the connection between his novels and these existential concerns. The importance of Kierkegaard in his work, his theory of language, and his early essays are discussed.

The contributors give examples of how Walker Percy's life and work are incorporated in medical education and the practice of medicine, both in personal and theoretical terms. Percy's work reminds practitioners of the necessity for human connection in the midst of scientific and technologic paradigms that distance practitioner from patient. Likewise, medicine and medical education shaped Percy the novelist, where keen observation and sustained searching for answers are to be found in all of his fiction.

A feminist critique of Percy's development of women characters, reflections on physician characters in Percy's work, his personal struggle with a family history of depression, and his attitudes about psychiatry and psychoanalysis complete the collection.

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Summary:

Dr. Ernest Lash, single and around 40, discovers his enthusiasm and love for psychoanalysis, the talking therapy, after several years of practice as a psychopharmacologist. As the novel opens, we meet a smart, somewhat smug and self-absorbed Dr. Lash who practices from his office located in the privileged community surrounding Sacramento Street in San Francisco. He has an active psychoanalytic practice, ambition for respect and notice by the seniors of his professional community, and some aspiration to greater success as a theoretician and writer on the subject of psychoanalysis. Central to his character is a love for his work, where it appears that pride in technique and outcome shadows genuine concern for his patients and their unhappiness.

Early in the novel, a male patient, Justin, who has been working with Ernest for several years, announces that he is leaving his wife, Carol, for another woman. Ernest is pleased since he views the marriage between Justin and Carol as unhealthy, while a bit dismayed that Justin fails to acknowledge Ernest's contribution in helping Justin develop the confidence to take this step. Justin ends his relationship with Ernest Lash--feeling that he no longer needs his help--as the beginning of the novel takes an intriguing direction.

Justin's now abandoned wife, Carol, in a state of betrayal and desire for vengeance--she has a hateful attitude toward all psychiatrists after her psychotherapist of many years ago had an affair with her--decides to enter therapy with Dr. Ernest Lash in the hope of seducing him. She disguises herself with a name change and enough distortion of her past and present so that Dr. Lash will not be able to connect her to Justin. She wishes to expose him as a charlatan, and destroy his career.

Carol is an attorney, and smart. Dr. Ernest Lash is lonely and drawn to Carol. The therapy sessions and the progression of their relationship are central to Yalom's exploration of the intersubjective experience, where strangers struggle with the ambiguity of their own motives and intentions in the intimate world of psychoanalysis. Who is giving, who is receiving? Who is being helped, and who is helping?

Yalom weaves this central element of the plot with many other relationships. Dr. Marshal Streider is a senior psychoanalyst with ambitions for national recognition and a preoccupation with money. He is Dr. Ernest Lash's supervisor. He takes great pride in the fact that he treats many wealthy patients, and is engaged in his own boundary dilemmas when he invests, using insider information from one of his patients.

Dr. Seymour Trotter is a senior psychoanalyst who is condemned and removed from psychoanalytic practice after entering a sexual relationship with one of his patients. We learn that Seymour Trotter was once president of the American Psychiatric Association, and a mentor to Marshal Streider. His maxim, "My technique is to abandon all technique" (p. 7), both haunts and guides Ernest Lash throughout the novel as Ernest grapples with his own passions and temptations, while striving in his goal to achieve humane and healing therapy for his patients.

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Dr. Pensack writes in the first chapter of his memoir: "Through a lifetime I have been in the process of dying, consistently surprised when reminded that life is appallingly brief, and briefer still for me. The prospect of an early death has amounted to little more than embarrassment and loneliness, even though the routine of living can be, and usually is, just one goddamn thing after another. A new heart was somehow supposed to be my bloody-red carpet of victory." (p. 7)

At age 4, Pensack's mother died of IHSS, Idiopathic Hypertrophic Subaortic Stenosis--now known as HCM, Hypertrophic Cardiomyopathy, a genetically inherited, progressive disease of heart muscle that results in early death. At age 15, Pensack receives the terrible news of his own fate--the disease afflicts both Pensack and his older brother--and thus launches a life of near death experiences, numerous hospitalizations, early experiences at the National Institutes of Health with early investigators of the disease, pursuit of his own medical training and eventual specialty training in psychiatry, marriage and children, and ultimately, the waiting and eventual transplantation of a younger man's heart into his chest at the University of Colorado Health Sciences Center when Pensack was 43.

Raising Lazarus tells of Pensack's journey through much of this, including his descent into madness, his fury and anger with medical colleagues, his poignant relationship with the heart surgeon who eventually performs the transplant, and the importance of his family in his refusal to die. While much of the book tells of the events leading to the transplant and post-operative period of Pensack's life, the reader learns of Pensack's early losses, including the death of his mother, and how these experiences shape the values of a gutsy and determined survivor, a man who continually returns to the struggle.

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Summary:

Dr. Tom More, from Love in the Ruins (see this database), now middle-aged, returns to Feliciana after spending two years in prison for selling prescriptions of Dalmane and Desoxyn at a truckstop. On his return to his psychiatric practice, More observes that two of his former patients are acting strangely. In his own words: "In each there has occurred a sloughing away of the old terrors, worries, rages, a shedding of guilt like last year's snakeskin, and in its place is a mild fond vacancy, a species of unfocused animal good spirits." (21)

More observes that his wife Ellen and his children have also undergone some mysterious personality change. More, the scientist-physician, with the help of his cousin Dr. Lucy Lipscomb, launches a search for the cause of these and other observations. More and Lucy discover that John Van Dorn, head of the computer division of the nearby Grand Mer nuclear power plant and Dr. Bob Comeaux, director of the Quality-of-Life Division of the Federal Complex overseeing euthanasia programs, are involved in social engineering, releasing Heavy Sodium into the water supply to "improve" the social welfare.

Throughout the novel, Dr. Tom More returns several times to evaluate and talk with Father Rinaldo Smith, a parish priest who has exiled himself to a firetower overlooking the vast pine forest of Feliciana. More has been asked by Comeaux, who sits on the probationary board overseeing More's return to practice, to declare Father Smith crazy, so that Comeaux can take over Father Smith's hospice and put it to better use. The conversations between More and Father Smith contain the philosophic and moral themes that support the plot and action of the novel.

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Summary:

The story begins in 1882, when Friedrich Nietzsche's beautiful and mysterious former lover convinces the famous Viennese physician and mentor to Sigmund Freud, Joseph Breuer, to cure Nietzsche of his "despair" so that the world will not be deprived of the "most important philosopher of the next 100 years." Breuer is known throughout Europe for his use of hypnosis and the "talking treatment" that have been successful in the treatment of hysteria.

Since Nietzsche is skeptical of what Breuer can do for him, Breuer offers the challenge that they might help each other. Through subterfuge, Breuer convinces Nietzsche to remain for 1 month in the Lauzon Clinic. Their bargain: Breuer agrees to treat Nietzsche for his chronic migraine headaches, if Nietzsche, the great philosopher, will listen to and cure Breuer of his own despair. What follows is a brilliant tour de force in which the two men engage in daily discussion, bantering, and intrigue, much like a chess game, jockeying for position, as both men are transformed in unpredictable and astonishing ways.

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