Showing 1 - 10 of 120 annotations in the genre "Treatise"

The Genetic Lottery: Why DNA Matters for Social Equality

Paige Harden, Kathryn

Last Updated: Mar-28-2022
Annotated by:
Trachtman, Howard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The Graduate is a movie classic from what seems like a bygone era. It is accompanied by great music by Simon and Garfunkel and has one of the most famous one-word lines in cinema history. When Benjamin Braddock is wandering aimlessly around the pool at a graduation party thrown in his honor, a friend of his parents asks him what he plans to do with his post-collegiate life. Another family friend jumps in and volunteers, “Plastics.” There are many who will also give a one-word answer to any medical school graduate searching for a career – Genetics.

In this important new book,  Kathryn Harden provides staunch support for the key role of genetics in health, disease, and in human well-being. She provides a remarkably clear primer on genetics in accessible language. Harden begins with statistical issues like the normal distribution and Bayesian priors. In her capable intellectual hands, she uses analogies that effectively move the teaching agenda forward. With recipes as a framing image for genetics, she demonstrates the relationship between the coding material in the DNA nucleotide sequence and the actual building blocks, namely the proteins that do the heavy lifting inside cells. Concepts like genetic recombination, linkage disequilibrium, and monogenic versus polygenic disorders are introduced and make perfect sense. She then builds on this foundation to consider genome-wide association studies (GWAS) which represent the powerful tool that has been introduced to explore the relationship between genetic endowment and health. That is where things start getting complicated.

When people think of medical genetics, they usually have classical Mendelian disorders in mind. They are caused by mutations in a single gene that disrupts a protein pivotal to normal health. Examples are sickle cell disease, hemophilia A, or muscular dystrophy. However, many health problems like hypertension that are associated with significant global disease burden are polygenic. This means that they are caused by less dramatic mutations in a number of genes that in the aggregate lead to the disease.  Harden details how quantitative assessment of the contribution of these minor variations in a large array of discrete genes enables the formulation of polygenic risk scores (PRS) for these conditions. These measures provide estimates of susceptibility to developing other polygenic conditions like obesity, cardiovascular disease, and diabetes.

As a psychologist, Harden’s work focuses on the application of PRS to non-medical aspects of human behavior such as impulsivity, attentiveness, job satisfaction, and executive function. The waters remain relatively calm until Harden’s fellow psychologists venture into the realm of educational achievement and lifetime income status. Harden methodically reviews relevant studies that have been done with siblings, twins, adoptees, and family trios. She dissects them and highlights when investigators have misinterpreted their data. There is a steady drumbeat of data, almost too much at times. But the overall consensus that emerges is that PRS and other measures of heritability continue to show a genetic component for these psychosocial outcomes in large population studies. The challenge that Harden raises is how to incorporate this knowledge about genetics into a better understanding of these aspects of human behavior and if and how to address abnormal manifestations.

Questions remain concerning how genetics “causes” these changes and how to interpret the findings. What is determinative? Is it genetics i.e., nature, or is it all environment i.e., nurture? There are those, like Harden, who advocate for thoughtful analysis and utilization of all the GWAS data. She highlights the difference between use of PRS to assess outcomes within populations versus between populations. In sharp contrast, there are others who resist  the introduction of genetics into psychology. Pointing to the sordid history of eugenics and its degeneration into the creation of racial hierarchies, the opponents of the Harden’s work dismiss it as unscientific at best and destructive at worst. Harden makes a compelling case for the validity of the science and a spirited defense of the thoughtful use of genetics dismiss it as unscientific at best and morally repugnant at worst.

Harden provides a strong defense of the science and statistical methods and offers a spirited argument that without acknowledging the role of genetics in human achievement, society will be unable to thoughtfully address inequalities and restore balance. Her work touches on many other pressing issues including human autonomy, agency, freewill and the role of government intervention. She outlines a social agenda that acknowledges the importance of genetics as a contributing factor. But it incorporates a recognition that its distribution in the population is solely a matter of luck and does not serve as the basis for a hierarchy of human worth. I leave it to readers to judge for themselves the validity of her proposals, but her commitment to making this world a better place is not in question.

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The Hospital: Life, Death and Dollars in a Small American Town

Alexander, Brian

Last Updated: Jul-14-2021
Annotated by:
Carter, III, Albert Howard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Native Ohioan Brian Alexander cares a lot about his state and its many economic problems, especially as they impact healthcare. For this book, he’s an on-the-ground reporter covering the events in and around a hospital in the small town of Bryan from 2018 to 2020. He is also an in-depth interpreter, analyzing the many dilemmas of this small hospital and emphasizing that these represent parallel problems of social justice for all of contemporary American healthcare.  An opening chapter reviews some of the difficult history of this area, including economic collapse, lack of public health, lack of health insurance, and collapse of jobs in supply chains for Detroit.           

While the timeline of the story is short, it has wide breadth in local and national issues. These are illustrated by the stories  of specific people. Marc Tingle, a local contractor has a heart attack; his wife falls ill and is diagnosed with cancer. Medical bills mount up. Marc has a second heart attack and a stent inserted. He, like many others receives “rescue” medicine, not preventive healthcare, due to social or economic issues beyond their control. Similarly, we read about Keith Swihart, overweight and diabetic. He has a foot ulcer that requires surgery and later partial amputation. He has eye problems that progress to near blindness. Valerie Moreno injures her back at work but does not report it to the company, considering herself tough, but she must have spine surgery. After being laid off, she has part-time jobs, money problems, and turns to OxyContin pills. These are dramatic and painful stories.  

Many families make “just enough money to disqualify themselves…from Medicaid, but not enough to afford coverage offered by an employer or via the Affordable Care Act” (p. 242).            

Such patients illustrate a deadly whirlpool of issues: lack of routine medical care, inadequate health insurance, no national health program, a collapsed economy with no good jobs or prospects of advancement, poor nutrition, pervasive poverty, racism, sexism, and more.           

Amidst all this, we follow Phil Ennen, the CEO of this hospital (CHWC--for Community Hospitals and Wellness Centers) in Bryan. He wants to rely on his local, traditional values of “we can fix this,” but now he must confront the threats of national hospital chains, the need to cut staff and services, and the seductive lures of adding for-profit and high-tech services. Eventually, he sees no path forward and accepts the board’s invitation to retire. His replacement will have all the same problems.           

A closing section sees the arrival of Covid-19, a threat to this hospital and, of course, the nation at large. Alexander writes, “the virus seeped into the fault lines created by American pathologies. The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit” (p. 268).  

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Fevers, Feuds, and Diamonds: Ebola and the Ravages of History

Farmer, Paul

Last Updated: Mar-19-2021
Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Fevers, Feuds, and Diamonds is Paul Farmer’s latest work exploring the connection between health and the social and historical structures that surround it.  Focusing on how and why Ebola spread in West Africa in 2014, the book is difficult to categorize — it is not only temporally expansive, ranging from the late 15th century to the present day, but it also combines elements of a memoir, an anthropological treatise, and an abbreviated historical text with powerful calls to action in over 500 pages.   

Stemming partially from a desire to fulfill a “personal penance for inaction” during the early days of the outbreak, Farmer chooses to learn about Ebola from “the personal histories of the Ebola dead, of survivors, and of their caregivers.”  Harking back to his days as a college anthropology major, many of the book’s themes, embodied in its title, are introduced via these in-depth interviews.  His two main subjects, Ibrahim and Yabom, are Ebola survivors who, after initially recovering from their illness, make it their work to support other Ebola survivors.  Through their words and narratives, we witness some of what it was like to experience the civil strife that predated the outbreak, see how Ebola expanded from isolated cases to clusters and communities, how family members sick with the disease were cared for, what it meant to survive Ebola, and now what it means to live with its sequelae.  Translation for Farmer was provided by Dr. Bailor Barrie, one of his former students, whose story as a medical student in Sierra Leone during its civil war soon becomes part of the narrative, as well.  Through the words of these three people, pieced together over many extensive conversations, a narrative is developed, allowing those most impacted by Ebola to tell its story. 

Farmer interweaves his first-person perspective with their stories, emphasizing his role in 2014 and how Partners in Health became involved in assisting in the outbreak.  While working in West Africa during the Ebola epidemic, late one night, Farmer mixes up Liberia and Sierra Leone.  Realizing how different their histories are, he vows to “make amends for my ignorance” and transitions from storytelling on the personal level to history-telling on the country level.  To ensure that he, and we, never mix them up again, Farmer traces the histories of Sierra Leone, Liberia, and Guinea in four chapters.  During this section, he refers back to the book’s title, taking on the effects of the rise of imperialism, colonization, the use of sanitation/Pasteurian principles, the impact of resource extraction, and much more on each of these nation’s stories and relationships with Ebola.  As he describes it, “if you want to understand the magnitude and dynamics of this Ebola epidemic, in other words, think in terms of fevers, feuds, and diamonds.” 

Fevers, Feuds, and Diamonds is bookended with reflections on COVID-19 in the introduction and epilogue.  In the introduction, he reflects on the book’s “obvious implications for our response to COVID-19” and how COVID-19, though different in many ways, shares certain similarities with Ebola — among them, the speculative nature of its origins and the fact that it is a zoonosis.  Most importantly, according to Farmer, treating and managing it will require understanding many of the same “cultural complexities and... challenges” that treating Ebola required.  After taking us on a journey through West Africa and up to 2014, Farmer writes an epilogue reflecting on how the central crisis of Ebola was the prioritization of “containment over care” whereas COVID-19 has become a crisis of containment.  To him, writing this on April 10th, 2020, and to the reader reading it a year later, COVID-19 is seen as partially a disease of healthcare workers’ exposure, and partially a disease of social inequity, but completely a disease whose management, treatment, and eventual control will be defined by the “staff and stuff and spaces and systems” in place and who has access to them.  Even with this pandemic at the forefront of our minds, Farmer reminds us that Ebola should not be off our radar just because a new disease is on it— there continue to be outbreaks of Ebola in the Congo.  Ultimately, Farmer’s words leave you thinking — about this pandemic, about the past, and about the connections between them.  If only to prompt more thought, one of Farmer’s last comments is also his most powerful: “If there’s indeed a lesson to be learned from Ebola, it may be this one:  for everything we do, or say, in pandemic time, let’s keep asking the same question.  Might this help?”







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Faith, Reason, and the Plague in Seventeenth-Century Tuscany

Cipolla, Carlo

Last Updated: Dec-31-2020
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Carlo Cipolla chronicles the 1630 bubonic plague outbreak in Northern Italy. At various places in the text, he refers to his compact volume as an “essay,” a “tale,” and a “book.” Readers during the 2020 coronavirus pandemic could call it a “prologue,” a “warning,” or a “horror story foretold.”  

The plague ravaged much of Northern Italy from 1630 to 1631. Cipolla focuses on a particular village, Monte Lupo, because “so exceptionally rich is the documentation of [its] story that it allows the historian to recapture emotions, attitudes, and behavior of common people.” The documentation led him to uncommon detail “on the relationship between Faith and Reason, Church and State at a social level” (p. ix). 

Reading like an historical essay, Cipolla first sets up the tensions arising between the Church and State Church during the plague epidemic. The “scientific revolution” had advanced enough by 1630 that regional Health Magistrates acted based on experience rather than faith. Most clergy and their followers still “preferred to believe rather than observe…[and] had not the slightest doubt: processions and similar ceremonies were the only way to placate divine wrath and put an end to the scourge” (p. 7). But, the divide between Church and State in this case is not so clear as that, Cipolla notes, because some of the senior Health Magistrates served as high-ranking church leaders themselves. 

Cipolla points to public health measures taken in Northern Italy before the 1630 plague outbreak that might have, ironically, heightened tensions, even though they were born from the terror and suffering epidemics caused during the previous two centuries. The changes that resulted were, in Cipolla’s view, “a strange mixture of brilliant intuition, sound common sense, and absurd prejudice” (p. 12). However rational these measures seemed, “they caused great misery and severe privations [through] the segregation of entire families in their homes, the separation of kindred in the horror of the pesthouses, the closing of markets and trade, the consequent lack of work and wide-spread unemployment, the burning of furnishings and goods” (p. 13). By the time the plague took hold in 1630, necessary public health measures were already unpopular. 

Cipolla uses the walled-village Monte Lupo as his case study. Around 150 families lived inside its walls when the plague struck during the summer of 1630. He details how Health Magistrates struggled to gain control of the outbreak while facing open rebellion fueled by “ignorance, egoism, avarice, and bullying” (p. 14). He names and profiles key figures and describes various events. 

The central event in Cipolla’s tale is a “procession” in Monte Lupo featuring a crucifix people believed had “miraculous properties” (p. 41). The Health Magistracy took aggressive actions to prevent and then stop the procession. Alas, Cipolla reports: “All this was in vain. It was like preaching to the wind: the church was soon packed with men and women, boys and girls, who had come to gaze at and adore the crucifix,” (p. 47). Festivities carried into the evening and on to a neighboring town (San Miniatello). Mayhem, illness, and death ensued.  

The last death in Monte Lupo occurred on August 11. Cipolla follows the subsequent investigations searching for people encouraging exposure to a lethal, contagious disease, and for people who became infected and died as a result. He reflects on the juxtaposition of epidemiological methods used to stop the epidemic and the fight religious leaders and followers waged against them. He muses about “emotions, attitudes, and behavior of all segments of a society in a period distant in many ways from our own” (p. 85). Written in 1977, the objects of his musing were only four decades distant from becoming evident again. 

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Global Healing

Thornber, Karen

Last Updated: Dec-14-2020
Annotated by:
Bruell , Lucy

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Karen Thornber is the Harry Tuchman Levin Professor in Literature and Professor of East Asian Languages and Civilizations at Harvard. In this expansive nearly 700 page book, she draws on work from global literature to explore the many ways societies view illness, stigma and healing.  She defines global literature as “narratives that grapple with challenges and crises that have global implications or counterparts globally, whether at present, in the past, or likely in the future” (p.10). 

The book is divided into three sections: Shattering Stigmas, in which she looks at Leprosy, AIDS, and Alzheimer’s disease; Humanizing Healthcare; and Prioritizing Partnerships.  Among the topics she addresses are patient-focused care as an imperative, the need to advance partnerships in caregiving, and support that extends beyond family and friends to the patient’s relationships with health professionals.  Healing, she notes, involves “changing the circumstances that exacerbate or even trigger a health condition, enabling the individual to obtain long-term wellbeing liberated from as much distress, if not disease, as possible.” (P331).

Thornber has selected literature that addresses the illness experience and the need to reduce suffering and promote healing, which she places within three interwoven  frameworks:  “Societies/communities, healthcare settings, and families/ friendships” (p.583).  She looks at both positive approaches to care as well as the negative impact of suffering, whether from stigma, inaccessibility to care, or dehumanized care. The book considers literary works from Africa, Asia, Europe, the Middle East, and Oceania, many that will be new to readers.  

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Which Country Has the World’s Best Health Care?

Emanuel, Ezekiel

Last Updated: Dec-05-2020
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The author, Ezekiel J. Emanuel, says his book title “is a terrible question” (p. 1), because “it is not possible to select the best health care system overall.” However, he continues, “it is possible and reasonable to make judgments about better and worse systems” (p. 351), such as considering “which country has the best consumer choice,…the most innovative health care system,…or best addresses the needs of chronically ill patients” (p. 7). And, that’s what he does.

Emanuel and his research partners compare eleven, high-income countries: United States, Canada, United Kingdom, Netherlands, Norway, France, Switzerland, Canada, Australia, Taiwan, and China. They examine eight content areas: history; coverage; financing; payment; the delivery of care; prescription drug regulation; human resources; and future challenges. These content areas serve as the subject headings for the chapters covering each country. In the penultimate chapter, “Who’s the Best?,” Emanuel assesses and judges each content area across countries. (Spoiler alert: the United States does not fare well.) The concluding chapter is built around “six lessons for improving the US health care system” (p. 385), followed by a coda where Emanuel considers how his findings relate to the coronavirus pandemic.

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Scales to Scalpels: Doctors Who Practice the Healing Arts of Music and Medicine

Wong, Lisa

Last Updated: Nov-01-2020
Annotated by:
Carter, III, Albert Howard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This is a quick and personal history of the Longwood Symphony Orchestra (LSO), a group of Boston area musicians who, in their working lives, are medical personnel. The first of its kind, there are now several such orchestras across the US and scattered throughout the world, notably in Europe. Lisa Wong, a pediatrician and violinist, tells her own history of medicine and music, including her involvement with the Longwood Symphony Orchestra over some 28 years. Other stories of individual doctor/musicians are threaded throughout the book, giving us a personal look at their interdisciplinary enterprise. While their medical specialties, ages, and backgrounds vary widely, while playing in the orchestra and, various professional ranks aside, they accept the direction of the conductor. While Wong mentions antecedents of medicine and music in ancient times, she chooses Dr. Albert Schweitzer as a patron saint for the LSO.

For Wong and her fellow doctors, there are links between music and healing. Music helps keep doctors (and patients) healthy by calming the heartbeat, relaxing muscles, and lifting the mind (p. 86). Music therapy (the psychotherapeutic use of music) and music medicine (the more general uses of music, often in medical settings) can assist in patient care. For example, a dementia patient named Ruth reawakened upon hearing music. Some patients choose to listen to music in the final days of their lives (p. 184).      

For many doctors, music was an early pursuit. Neurological studies suggest that musical training helps develop “structural brain plasticity” that may show benefits in education and training. By contrast, however, sometimes musicians (doctors or not) develop overuse injuries and need specific physical therapy.           

Music has applications in mental health, hospitals in general, and community partners. The LSO has partnered with some 40 nonprofits in the Boston area. In one example, they helped grow the Asian bone marrow registry from 3,000 to 11,000 people (p. 225). An LSO concert raised $30,000 for the Mattapan Community Health Center in South Boston.  

Lisa Wong was president of the organization for 20 years. She writes, “Music goes a long way to heal entire communities. Social justice and social welfare are important determinants of health. Programs that look beyond the music are truly ‘Healing the Community through Music’” (p. 249). 

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Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland

Metzl, Jonathan

Last Updated: Oct-08-2019
Annotated by:
Carter, III, Albert Howard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This illuminating and disturbing book explores how various forms of white supremacy became expressed in policies, laws, and elected officials, such as Donald Trump. Physician and sociologist Metzl details social changes in Missouri, Tennessee, and Kansas, where white Americans backed changes that, ironically, dramatically harmed them with gun suicides, school dropouts, worse healthcare, and shorter life spans. For Metzl, “Whiteness” refers not to skin color but to a political and economic system of white privilege.

Metzl's thesis that: “Trump supporters were willing to put their lives on the line in support of their political beliefs” was, in fact, a sort of “self-sabotage” (pp. 5-6). While a conservative political movement fostered white racial resentment, largely in lower-income communities, the mainstream GOP did its part by crafting policies against the Affordable Care Act, higher taxes, and restrictions on guns. An atmosphere of polarization and political stasis grew. Metzl writes: “Compromise, in many ways, coded as treason” (p. 11).  

Metzl focuses on the examples of Missouri, Tennessee, and Kansas to “suggest how the racial system of American fails everyone” (pp. 16, 20). He visits each state, leading focus groups, interviewing formally and informally, reading newspapers, and inductively formulating concepts that seem to explain the nonsensical behavior of rejecting helpful programs. For example, because “risk” in Missouri has become a code name for possible attacks by black people, white people buy guns, especially when restrictions are removed. Many white men feel that a gun (or many guns) restores their privilege, but suicide of white males, often low-income, goes up. Metzl’s statistics and charts show contrasts with other states with stricter laws and lower suicide rates. He calls for preventive medicine to lower such deaths.  

For Tennessee, the Affordable Care Act offered many benefits to poor or middle-income people, but Republicans (and especially Trump) attacked it as big government over-reach, socialism, exorbitant cost, a program that would help minority people, for example “welfare queens.” “Cost” became a proxy for the “we don’t like it,” even when the economics would be favorable for good healthcare for all. Blacks were generally in favor of ACA, but white blue-collar men swore by their independence and autonomy. Neighboring Kentucky accepted ACA, and ten graphs included in the book clearly chart the better outcomes for Kentucky in such areas as insurance coverage, death rates, and seeing a doctor.  

Metzl returns to Kansas, where he grew up and recalls the pride Kansans had in their state. Republican Governor Sam Brownback enacted massive tax cuts with large reductions to state services and school funding, an “experiment” in “epic defunding.” The GOP, Tea Party, Koch brothers, and “trickle down” theories all played a part in benefiting the wealthy financially, while minority and lower-income groups paid more. Infrastructure, such as roads, suffered. Untested charter schools collected wealthy white students, while public schools plunged in funding, test scores, and graduation rates (see 17 graphs). Since education is a predictor of health, there are and will be long-term costs to Kansans, especially for minority groups.  

Metzl attacks the “Castle Doctrine” (“a man’s home is…”) as a symbol of narcissism, individualism, and as a risk for all citizens when social structures are abandoned. He closes with some hopeful examples of social change for the better.

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Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.

Aronson, Louise

Last Updated: Oct-07-2019
Annotated by:
Carter, III, Albert Howard

Primary Category: Literature / Nonfiction — Secondary Category: Literature /

Genre: Treatise

Summary:

Louise Aronson, a geriatrician, argues that we should create Elderhood as the third era of human aging, joining the earlier Childhood and Adulthood. This new concept will allow us to re-evaluate the richness of this later time, its challenges as body systems decline, and, of course, the choices of managing death. This important and valuable book is a polemic against modern medicine’s limits, its reductive focus, and structural violence against both patients and physicians. She argues for a wider vision of care that emphasizes well-being and health maintenance for not only elders but for every stage of life.   
          
Aronson argues that contemporary society favors youth and values of action, speed, and ambition, while it ignores—even dislikes—aging, older people, and the elderly. She says ageism is more powerful than sexism or racism—as bad as those are. Medical schools ignore the elderly, focusing on younger patients, especially men, and medical students perceive geriatrics as boring, sad, and poorly paid. Primary care, in general, seems routine and dull. By contrast, medical treatments, especially high-tech, are exciting and lucrative. In medical schools a “hidden curriculum” focuses on pathophysiology, organ systems, and drugs, ignoring patients’ variability as well as their suffering and pathos. Further, business and industrial models make “healthcare” a commodity, and nowadays “doctors treat computers, not people” (p. 237). Aging has become “medicalized” as a disease. Medicine fights death as an enemy, often with futile treatment that may extend a dying process.
        
Instead, Aronson says we need to bring back the human element, putting care of people at the center, not science. She calls for a new paradigm with ten assumptions (p. 378). Number 2 reads: “Health matters more to both individuals and society than medicine.” Number 9 claims, “As an institution, medicine should prioritize the interests of the people over its own.”  
      
Many practical changes would follow, from redesigned “child-proof” drug containers to buildings and public spaces that are more congenial to older people—and, in fact, to everyone else. We should change our attitudes about old age. For example, we might use the adjective “silver” for a medical facility that is friendly to and usable by older people. Changing our attitudes about aging can help all of us imagine more positive futures for each one of us and for all of our society.

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The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science

Jain, Shaili

Last Updated: Jun-19-2019
Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

A psychiatrist and PTSD (post-traumatic stress disorder) specialist, Dr. Shaili Jain has written a book on PTSD and its many angles, from diagnosis to treatment to a larger perspective on cultural and historic influences on the development of traumatic stress. She weaves the story of her own family’s experience with the Partition of India and Pakistan in 1947, particularly its effect on her father and grandparents, as a way to consider the effect of trauma on family, but also how those traumas become ‘unspeakable.’  

A brief but effective introduction outlines the seven parts of the book:
1. Discovering Traumatic Stress: historical perspective and the changing language to describe the effects of trauma.
2. The Brain: the physiologic and psychological underpinnings of PTSD, including effects on memory formation and retrieval.
3. The Body:  such as addiction, cardiac effects and concerns at different stages of life.
4. Quality of Life: domestic and sexual violence, socioeconomic factors.
5. Treating Traumatic Stress: programs, treatment strategies and psychopharmacology.
6. Our World on Trauma: global health, large scale tragedy, terror and war.
7. A New Era: An Ounce of Prevention: resilience, accessibility of care including early and preventative care. 

Additionally, almost 100 pages of notes, glossary, resources and an index provide an easy way to further explore, to use the book to look up specific topics, and underscore the heavily researched nature of the text.   The book is eminently readable, with numerous, well-placed stories of patient encounters and particular experiences and manifestations of PTSD.  These stories are illustrative of the concepts Jain ably explains. However, they also provide an insider’s view of what happens in the consulting room.  In the prologue, Jain describes a young Afghanistan War veteran, who has been hospitalized after a violent outbreak at a birthday party: “Josh’s PTSD was fresh, florid, and untreated…. His earlier poise caves in to reality, and his face falls to anguish.” (p. xvi) We are in the room, listening to the patient, witnessing the tears of the medical student, glimpsing the attending psychiatrist’s response, and relating to Jain, as a psychiatry chief resident, as she understands that the individual before her, even as he shows classic signs of traumatic stress, remains an individual, a person in need of care.   

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