LitMed: Literature Arts Medicine Database

The Best Minds

Rosen, Jonathan

Last Updated: Jun-26-2023

Glass, Guy

Primary Category: Literature / Nonfiction

Summary:

The Best Minds is the true story of the lifelong friendship between the author, Jonathan Rosen, and Michael Laudor. To an extent, as children and young adults, Rosen lives in his brilliant friend’s shadow. While both attend Yale, it is Laudor who graduates summa cum laude in three years. Laudor applies and is admitted to all the top law schools, and, at twenty-four, seems to be destined for great things. Then, a switch flips. His parents have been replaced by Nazis, or so he claims. He roams the house with a kitchen knife. His mother locks herself in the bathroom and calls the police. Rosen gets a call. His friend is in a psychiatric hospital. He has been diagnosed with Paranoid Schizophrenia.

After being stabilized on antipsychotics, Laudor is discharged to a halfway house and begins to attend a day hospital. “Painfully aware of where he had been and where he ought to be” (p.243), he is advised to get a job as a cashier at Macy’s. Instead, he makes the extraordinary decision to matriculate at Yale Law School, whose acceptance he has deferred. At school, he wakes up every morning believing his room is on fire, “paralyzed with fear until his father called and told him the flames weren’t real” (p.277). Incredibly, with the encouragement of the dean and faculty, who “create a day hospital” (p.262) for Laudor and his classmates who read, edit, and type his work, he manages to graduate.

Laudor looks for a job, but determined to be open about his illness, seems unemployable. Nevertheless, he is in a unique position to be a powerful advocate. He is interviewed by the New York Times and is portrayed in glowing terms in a widely circulated article. There are bidding wars among several publishers for a book he is to write. Leonardo DiCaprio expresses interest in playing him in a film. He receives a large advance which obviates the need for employment. For the director of the National Alliance on Mental Illness (NAMI) this is the perfect “opportunity to give the world a positive image of someone with serious mental illness” (p.406).

Unfortunately, Laudor is not compliant with his medication. His personal care and his thought processes deteriorate. However, since he knows how to “avoid the buzzwords that could trip a psychiatric alarm” (p.423) he evades treatment. Eventually he spirals into full-blown psychosis, and convinced his fiancée has been replaced by a wind-up doll, he stabs her to death.

Laudor is considered unfit to stand trial and is committed to a forensic psychiatric facility. His book is never written, and the film director who was to tell his story instead makes A Beautiful Mind, which wins many awards. After years of estrangement, Jonathan Rosen begins to visit his childhood friend again. Laudor remains institutionalized to the present day.

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Sinkhole

Patterson, Juliet

Last Updated: Jan-18-2023

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The first few pages of Sinkhole recount the final moments of the author’s father’s life, as the author imagines they occurred. Slipping away from the bedroom where his wife sleeps, her father writes a note and leaves the house for the last time. It is nearly zero degrees in Minneapolis as he proceeds to the park where he usually walks his dog. All of this has been methodically planned: “My father chooses to die on the north end of the bridge. There, the canopy is so dense that, from the street, the structure appears to grow from the hill. In the dim light spreading from the railings, the crown of its arch bestows darkness” (p.4).

Immediately following her father’s suicide, author Juliet Patterson is, naturally, overcome. After the initial shock, she begins to wonder about her father’s motivation. She realizes she did not know him as well as she had thought. Theirs is a family that “rarely talked about important things” (p.9). One of those things is that both her father’s father and mother’s father had also taken their own lives. She begins to ask questions: “Who were these men? What led to these deaths in my family? What did my family’s history of suicide imply? And what did it mean for my own future?” (p.10) The remainder of Sinkhole tells the story of how the author investigates the death of her grandfathers, a quest that takes her back to her family’s ancestral home in Kansas.

One day, on an impulse, the author locates her grandmother’s abandoned house. Like other properties in this part of the country where there were formerly mines, it has fallen into a sinkhole. She sees the “terrifying alien world of a sinkhole” (p.111) as a metaphor for “a realm that I could not enter,” as she struggles to make sense of her family’s past. Eventually she undergoes a transformation and comes to terms with her loss. The least she can do to break the cycle is to be honest about her family history with her young son.

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What She Left Behind

Wiseman, Ellen

Last Updated: Jan-03-2023

Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Izzy is a teenager who has been in foster care for a decade since the age of 7 when her mother was imprisoned and judged insane for having killed her father. She struggles with a desire to cut herself. Her current foster parents, Harry and Peg, seem kindly and engage Izzy in their task to catalogue artifacts from the nearby state asylum that has recently closed.

Izzy is given the journal of Clara, a patient who, at age 18 in 1929, was pregnant by her Italian lover, Bruno. She was committed to the asylum by her angry father. Clara gave birth, but her baby girl was taken from her. She observed how the brutality of the hospital damaged those who did not belong there, eventually provoking the mental illness it purported to treat. With the help of a gravedigger, Bruno planned an escape, but their plan was uncovered, and Bruno died.

Izzy’s own story unfolds as she works her way through the journal, subjected to bullying and tormented by her anxieties. Peg kindly arranges to take Izzy to see her dying birth mother in prison, where she learns that the murder of her father was to prevent him from abusing young Izzy.

Spoiler alert! Izzy learns from an elderly nurse that the asylum director took Clara’s baby for himself and that Clara is still alive. She reunites the mother and child, who is now a grown woman. Izzy joyfully learns that Peg and Harry will formally adopt her.

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Strangers to Ourselves: Unsettled Minds and the Stories That Make Us

Aviv, Rachel

Last Updated: Oct-18-2022

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

When Rachel Aviv, the author of Strangers to Ourselves, was six years old, she simply stopped eating. She said she got the idea from the Yom Kippur fast. She was promptly checked into a psychiatric hospital where she became one of the youngest-ever patients to be given the diagnosis of anorexia. Through associating with older, more seasoned anorexic girls she became a sort of “anorexic-in-training” (p.13). Fortunately, after a few months she snapped out of it, and was discharged. She never suffered from the same symptoms again.

As an adult, Aviv began to think about what had happened to her. The only remnant of her experience was a diary entry from age 8: “I had a diseas called anexexia” (p.231). Had she even had the disorder, or had the diagnosis been a mistake? Why had she not gone on to have “an anorexic ‘career’” (ibid.), while one of the girls who had mentored her ultimately died of anorexia-related causes? In order to answer these questions for herself, Aviv meets with the therapists who treated her more than thirty years ago as well as with the family of her deceased copatient.

As a result of Aviv’s introspection, she becomes intrigued by people whose psychiatric diagnoses do not fully capture the complexities of their situation. Strangers to Ourselves presents detailed case histories of several such individuals. Bapu is an Indian woman whose visions have caused her to be diagnosed with schizophrenia. Are they delusions, or is she a mystic? Naomi is a socially disadvantaged black woman who has struggled unsuccessfully to get ahead. During a manic episode, she jumps into a river with her young twins, one of whom dies. Her claim that “white people are out to get me” (p. 146) is ignored because her doctors insist that “delusions couldn’t on some level make sense” (p. 150). Yet another woman, Laura, bounces from diagnosis to diagnosis, and sleeps fourteen hours a day because of all the medication she is on. She becomes one of these people who no longer even know if their lack of functioning is “due to their underlying disorder [or] the heavy medications they’d taken for it” (p. 203).

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Vanished in Hiawatha: The Story of the Canton Asylum for Insane Indians

Joinson, Carla

Last Updated: Aug-08-2022

Galbo, MA, MILS, Sebastian

Primary Category: Literature / Nonfiction

Genre: History of Medicine

Summary:

In 1902, an unusual structure was erected on South Dakota’s windswept prairies. It was not a silo, farmhouse, or barn—buildings that would be perfectly commonplace in that corner of the state. This conspicuously odd edifice, a “two-story building, with its jasper granite foundations,” was called the Canton Asylum for Insane Indians, a first-of-its-kind and federally managed institution based outside of Canton, South Dakota (Joinson 24). The asylum, which operated from 1902 to 1934, was designed to incarcerate and treat Indigenous peoples deemed ‘mad’ by powerful political authorities, such as reservation superintendents and the Bureau of Indian Affairs. According to the historian and disability studies scholar, Susan Burch, the facility “ultimately held four hundred men, women, and children from seventeen states and nearly fifty tribal nations.”

In Vanished in Hiawatha: The Story of the Canton Asylum for Insane Indians, Carla Joinson provides an incisive institutional history of the Canton Asylum, examining the political motivations for its establishment, its different periods of (mis)management, and, ultimately, its demise in the early 1930s due to inspection findings and Indigenous affairs advocacy spurred by John Collier. In writing the book, Joinson seeks to answer her chief research question: “why an institution like this asylum could exist for so many years, and what made it tick as a viable part of the Interior Department” (2). Her research explores the mechanics of institutional longevity, specifically how, despite government inspection reports that revealed appalling evidence of neglect and abuse, the facility remained in operation for over three decades. Joinson’s book also corroborates the staggering fact that many of the asylum’s patients were not, in fact, ‘insane,’ but sent to the institution only so that the federal government could detain and surveil people who may have experienced difficulties with reservation authorities back home. Other Indigenous peoples, such as those with epilepsy and ‘feeblemindedness,’ were also deemed ‘mad’ and in need of medical detention. Many instances of abuse are chronicled: unhygienic conditions, patient restraint, fraudulent diagnoses and misdiagnoses, suicide, and failure to quarantine tubercular patients. Joinson also unearths decades-long dysfunction among the facility’s administration: staff backbiting and high turnover rates, lack of medical treatment, poor medical training and recordkeeping, and refusal to employ translators to communicate with Indigenous patients and understand their different cultures. Vanished in Hiawatha documents that Canton’s patients suffered years of neglect, and those who would have potentially benefitted from psychiatric treatment never received it because the facility was little more than a rural prison for unwanted, troublesome, and chronically ill Indigenous peoples.

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The Inkblots

Searls, Damion

Last Updated: Jun-14-2022

Madsen, Danielle

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

Damion Searls’ The Inkblots: Hermann Rorschach, His Iconic Test, and the Power of Seeing is a comprehensive history of Rorschach’s life and an overview of the use and influence of his psychiatric test over the past century.

Rorschach grew up in Switzerland, the son of a widowed middle school art teacher who would die while Rorschach was a teenager after suffering from years from neurological disease caused by lead paint exposure. Rorschach debates whether to study drawing and become a teacher or attend medical school and pursue a career in neurology. The book follows his career across three countries after choosing to do the latter, until he becomes a practicing psychiatrist at a rural Swiss institution. It traces his psychiatric influences—Bleuler and then Jung as professors while at the University of Zurich and Freud via their influence—as well as his artistic ones—Ernst Haeckel, the pre-modernist galleries of Zurich, then Russian Futurism. It also provides an overview of the field of psychiatry at the time: schizophrenia was considered an unremittable condition named dementia praecox, psychiatric institutions included patients with tertiary syphilis, and increasing neurologic knowledge and psychiatric techniques improved diagnostics but not treatments.

The earliest inkblots of Rorschach’s are temporary creations made with a local schoolteacher and administered to patients and pupils, formulated as one of dozens of strategies to gain insight into people. Rorschach’s patients see much in these inkblots, but the schoolboys little, and the experiment is abandoned. He returns to the idea a decade later, with greater stress placed on the image. He requires that they look organic rather than made, imply movement, and have multiple foreground/background interpretations. After creating a set of ten products, he starts to categorize results. He codes whether the answers are seen in the whole image or a detail; whether they are based on form, color, or movement; whether the figures seen in the image are well- or poorly-defined; and how many and what category of answers are seen. The coded results enable Rorschach to give accurate blind diagnoses and he begins to gain traction in psychiatric community. However, he dies before his inkblots become popular.

The book follows the test as it travels to America and gains acclaim with psychologists. It is used in clinic and hospitals and becomes a standard part of psychology training. The inkblots are part of military personnel assessments and scientific studies. They are referenced in criminal trials and family court. They are applied in anthropology and education. They show up on movie posters and in fashion shows and become a household name. As it details these broad applications, the book explains the battle over how the test should be given and whether analysis of the results should be open-ended interpretation or a standardized scoring method. It also details society’s constantly shifting belief as to whether psychological testing is a valid diagnostic tool.

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The Urge: Our History of Addiction

Fisher, Carl Erik

Last Updated: May-02-2022

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Urge: Our History of Addiction, by Carl Erik Fisher, a psychiatrist, is really two books in one. It is a comprehensive history of addiction from ancient times to the present day. It is also a memoir of the author’s own struggle with addiction and an attempt “to understand how I went from being a newly minted physician in a psychiatry residency program…to a psychiatric patient” (p.ix).

Fisher has grown up with two alcoholic parents. Even as his mother’s drinking “suppresses her blood counts and causes her to miss the chemo sessions I have worked so hard to arrange” (p. 294), she does not stop. Fisher’s own first drink, in high school, is a revelation. He blows his interview for his first-choice college when he shows up late and hung over. His intelligence enables him to get by, but eventually the problem catches up with him as he begins to use Adderall and marijuana to counteract the effects of alcohol. After sleeping through and missing his residency orientation, he is under scrutiny. Finally, he has a drug-induced manic episode that results in his being tasered by the police, and he is forced into treatment.

In the historical sequences of the book, we discover that one of the oldest known examples of addiction is found as far back as the Rig Veda (1000 BC). From there we move through time, learning how Native American populations were devastated by alcohol, how Alcoholics Anonymous achieved prominence, and about the multiple challenges that persist to the present day.

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One Friday in April

Antrim, Donald

Last Updated: Feb-08-2022

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

As One Friday in April opens, we find Donald Antrim in an agitated state on the roof of his Brooklyn apartment building. He paces, and alternately climbs down the fire escape, hangs from the railing, and lies on his stomach peering over the ledge. Repeated outpatient courses of psychotropic medication and psychotherapy have done only so much for his deteriorating mental state, and the situation has come to a head. Disheveled and wild-looking, he manages to return home whereupon his friends take him to a psychiatric hospital.

A MacArthur Fellow and author of several acclaimed novels, Antrim has previously published a memoir of his upbringing with his alcoholic mother. In this new memoir, flashbacks of childhood neglect and chaos are juxtaposed with the present day as he takes the reader through the acute phase of his illness: a lengthy hospitalization, a course of ECT, discharge from the hospital, rehospitalization, and eventual stabilization.

The author considers his condition to be suicide, noting that “depression is a concavity, a sloping downward and a return. Suicide, in my experience, is not that. I believe that suicide is a natural history, a disease process, not an act or a choice, a decision or a wish…I will refer to suicide, not depression” (pp. 14-15).

The book ends on a hopeful note. After several relationships that might be described as codependent, Antrim meets his current partner, whom he marries. He sees the roof of his building through his window and remembers a certain Friday in April but is comforted by the sound of his wife playing Chopin and Bach on the piano.

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The Problem of Alzheimer’s

Karlawish, Jason

Last Updated: Nov-29-2021

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5). He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease.

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease.

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections.

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How To Be Depressed

Scialabba, George

Last Updated: Nov-28-2021

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

How To Be Depressed is a book with a most unusual structure. It is introduced by an essay entitled “Intake” that was previously published in a literary magazine. The bulk of the book, “Documentia,” is taken up by an edited selection of the author’s psychiatric records from 1969 to 2016. It is rounded out by an interview with the author and by his “Tips for the Depressed.”

Author George Scialabba ascribes his “exceptionally flimsy…shock absorbers” to his “constantly worried” parents (p.3). While studying at Harvard he becomes involved with a strict religious organization. After leaving that group he undergoes a crisis of faith and his first episode of depression. Paralyzed by self-doubt, he drops out of graduate school and begins a cycle of clerical jobs that are beneath his intellectual capability. After many years he gradually wins distinction as a freelance essayist. However, due to his incapacitating symptoms he never has a steady writing job and has difficulty attaining financial security.

In his introduction, Scialabba tells us that “the pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything” (p.1). As attested to by the notes of his well-meaning psychiatrists and psychotherapists, he has diligently applied himself to a wide variety of treatments. Sadly, if anything he gets worse over time, and eventually requires electroconvulsive therapy.

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