LitMed: Literature Arts Medicine Database

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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The Genetic Lottery: Why DNA Matters for Social Equality

Paige Harden, Kathryn

Last Updated: Mar-28-2022

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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Prima Donna: The Psychology of Maria Callas

Wink, Paul

Last Updated: Feb-05-2021

Glass, Guy

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

Genre: Biography

Summary:

Maria Callas, the most famous opera singer of the second half of the 20th century, continues to exert a fascination. Critical consensus is that Callas fused a technically flawed voice with an extraordinary stage presence to create something unique. More than forty years after her death, Callas’s recordings continue to be best-sellers, and her life has inspired dozens of biographies. Prima Donna: The Psychology of Maria Callas appears in Oxford University Press’s Inner Lives series, which consists of psychobiographies of artists that make use of current psychological theory and research. The focus of author Paul Wink, a psychology professor at Wellesley College, is adult development and narcissism.

The facts of Callas’s life are well known. She is born in New York City to an ill-matched Greek immigrant couple. Her father is barely able to keep a roof over their heads. Her mother Litza struggles to get over the death of an infant son, requiring hospitalization for a suicide attempt. As the story goes, Litza cannot bring herself to look at her new daughter for the first four days of her life. Litza, who imagines herself in a lofty social class, disdains their neighbors, and thus Maria is discouraged from playing with other children. When Maria is discovered to have talent, Litza exploits her.

As Litza’s marriage deteriorates, she brings Maria back to Greece. With the onset of World War II, they endure hardships. Yet, improbably, the overweight and awkward Maria shows a streak of brilliance. She is the hardest working student at the conservatory, quickly outpacing her peers. On Maria’s first day in Italy, where she gets her first big break, she meets a businessman who is more than twice her age. Within weeks they are a couple. For a time, she allows Litza to share in her success, even buying her a fur coat. But soon, in response to a request for money, she tells her mother to “jump out of the window or drown yourself” (p. 78), and then never speaks to her again.

Maria loses weight and transforms into the operatic counterpart to Audrey Hepburn. She enjoys one operatic triumph after another. Nevertheless, she becomes as famous for her bellicose and imperious behavior as for her singing. She kicks a colleague in the shin after a performance so she can take a solo bow. She is publicly fired from the Metropolitan Opera. She incurs scandal by suddenly canceling a performance at which the president of Italy is present.

When the fabulously wealthy Aristotle Onassis courts her, Callas unceremoniously rids herself of her husband. Soon, her technical flaws catch up with her, and her career dwindles away. Meanwhile, Onassis goes for a bigger trophy: Jacqueline Kennedy, and Callas is humiliated in the press. Voiceless, she exiles herself to Paris with her two poodles, develops an addiction to sleeping pills, and dies a decade later, alone.

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Beautiful Boy

van Groeningen, Felix

Last Updated: Nov-30-2020

Brinker, Dustin

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

David Sheff (Steve Carell) and Nic Sheff (Timothée Chalamet) never had a stereotypical father-son relationship, one moment sharing a joint by a Volvo 240, another speaking Klingon in a small-town café in California. The fallout of divorce proceedings and long-distance shared custody seemed to solidify their relationship further; only Nic’s summer and holiday stays in LA with his mother could separate him from his journalist father–that is, until he starts experimenting with drugs. Beginning with marijuana and alcohol, Nic eventually finds himself using meth in his teens, his intellectual precocity feeding an existential need to escape. His substance use disorder, with meth at the forefront, takes hold of his life. Over the course of roughly five years, Nic fluctuates between relapse and sobriety, resulting in two failed attempts at college, multiple instances of theft and deceit, a car chase, and a hospital admission, supposedly at Bellevue Hospital. David Sheff is all the while present to varying degrees, supporting his son in his efforts at rehabilitation while being decimated by anxiety over his child’s well-being and multiple disappearances. His concern often undermines his other responsibilities, namely being fully present in the lives of his current wife, Karen, and his two young children, Jasper and Daisy. This tension reaches its climax when Nic’s mom calls David imploring for help in getting Nic treatment. David, having reached a breaking point, refuses, saying, “I don’t think you can save people” [01:42:33]. Soon thereafter, Nic graphically overdoses for the second time and miraculously survives. The film ends with David and Nic embracing in the courtyard of a rehab facility while the second movement of Górecki's Symphony no. 3 plays in the background. Before the credits, the audience learns that, at the time of the film’s final production, Nic had been sober for 8 years.

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Together

Murthy, Vivek

Last Updated: Nov-09-2020

Thomas, Shawn

Primary Category: Literature / Nonfiction

Genre: Longform journalism

Summary:

Since the first surgeon general was sworn into office in the 19th century, the Office of the Surgeon General has positioned itself as the leading voice on public health matters in the United States. In recent history, the office has had its highest profile campaigns rallying against issues such as tobacco use, obesity, and HIV/AIDS. Considering the combination of prevalence, morbidity, and mortality associated with these health issues, there is no doubt that any effort to stem the tide was a worthwhile endeavor.

When Dr. Vivek Murthy became the surgeon general in 2014, his office continued the historical campaigns against these health issues. At the same time, Dr. Murthy began investigating a looming epidemic within our borders: loneliness and social isolation.

It may be hard to convince the average person that loneliness is a problem of similar scale as tobacco use, obesity, or AIDS. There is no question that loneliness is unpleasant, even if it only lasts for a few moments. But the notion that one’s state of mind can predispose to disease or premature death somehow feels like a stretch. Addressing this skepticism, Dr. Murthy writes in his book about Dr. Julianne Holt-Lunstad, a psychologist at Brigham Young University who also faced a great deal of cynicism surrounding her research into the effect of social relationships on “everything from our behavior to our cellular function.” She had a breakthrough in 2010 when she published a massive study analyzing the health outcomes of over 300,000 participants, categorized by their degree of social connectedness. She found that social isolation was significantly linked to premature death, representing a risk nearly as serious as pack-per-day smoking, and more serious than obesity, alcohol use, and lack of exercise. Dr. Holt-Lunstad’s research spurred further studies which linked loneliness to heart disease, stroke, and depression, amongst other diseases.

These findings are hard to ignore, especially in light of the ongoing opioid addiction crisis and rises in teenage depression and suicide, all of which have been linked to loneliness and social isolation. In Together, Dr. Murthy weaves together scientific research, personal anecdotes, and current events to create a manifesto for tackling the next great public health crisis.

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Beloved

Morrison, Toni

Last Updated: Aug-15-2020

Brinker, Dustin

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Set in the 19th century United States, Beloved follows a formerly enslaved woman named Sethe and the lives of those closest to her. Sethe lives in a house known only as 124 outside of Cincinnati, Ohio. Not only is the house inhabited by Sethe and her eighteen-year-old daughter Denver, but it is also haunted by a poltergeist. 124 had been a gathering place for the area’s black community, led by the middle-aged Baby Suggs, another formerly enslaved woman. Prior to their move to Ohio, she and Sethe were held captive on the same Kentucky plantation called Sweet Home. Sethe was purchased for this plantation after Baby Suggs had been bought out by her son Halle who outsourced his labor in order to do so. Halle and Sethe were allowed to marry by the owners of the plantation, resulting in the birth of three children—two boys and a girl. In comparison to most other plantations, Sweet Home provided liberties rarely afforded to enslaved people, including choice of marriage, use of guns, lack of physical and humiliating punishment, input into work practices, and the aforementioned buy-out of Baby Suggs.

Conditions change once Sweet Home’s owner dies of a stroke and his widow brings in her brother-in-law and his young nephews to help run Sweet Home; the small liberties granted to the enslaved people are revoked by the new leadership, and cruelties ensue. The enslaved people, including Halle and a man named Paul D, plot to escape north; however, Sethe and her children are the only ones who succeed in doing so, only after she is violated by the nephews and brutally whipped by the brother-in-law for informing him of the assault. These events and Sethe’s flight are complicated by her near-full-term pregnancy. Approaching death from exhaustion and exposure, she is saved by a white girl who helps Sethe give birth. Her daughter is named Denver after the contextually benevolent white girl.

Carrying her newborn, Sethe arrives at 124, greeted by her other three children, into the care of Baby Suggs. The bittersweet happiness of her arrival without Halle is marred one month later by the arrival of a team intending to reclaim Sethe and her kids for Sweet Home. Rather than allow herself and her children to be forced back into slavery, Sethe intends to commit infanticide and suicide, succeeding in the murder of her older daughter. This action effectively prevents them from being taken, and Sethe is exonerated of her charges. Despite this, her act of desperation crushes her family, eventually leading to Baby Suggs’ death and to the flight of her sons from the household. Eighteen years later, Paul D arrives at 124. He begins a relationship with Sethe and manages to evict the poltergeist.

Soon thereafter, a strange woman arrives by the name of Beloved, the word Sethe had engraved on her child’s tombstone. Sethe is initially unaware of the stranger’s origins, and Paul D is effectively forced out by the new arrival. Once Beloved’s identity as the deceased child is understood, she, Sethe, and Denver become wrapped up in each other, blurring the lines of their identity. Sethe loses her job, but Denver manages to extricate herself to find work. Hearing of the family’s plight at the hands of the “unholy” Beloved, thirty black women of the area band together to purge 124 of her presence. Beloved leaves without a trace. Paul D eventually returns to 124, and memories of Beloved slowly fade into oblivion.

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Brave Story

Miyabe, Miyuki

Last Updated: Jul-20-2020

Brinker, Dustin

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Wataru Mitani is an average fifth-grade student in east Tokyo. Rumors of ghosts in a deserted, semi-built edifice lead this young boy and his friend Katchan to investigate it on their own. The next school day, they learn of a new transfer student named Mitsuru, a mysterious, handsome young boy whose standoffishness and manner of speaking make others think he’s far older than a middle-schooler. He becomes a centerpiece of the ghost rumors when he seems to accidentally take a picture of one while on an art class outing near the building. Meanwhile, Wataru starts hearing a mysterious voice at his home. He convinces himself that it’s a fairy à la his favorite video game, pushing him to follow Mitsuru’s lead and take pictures around his room in the hopes of catching a glimpse of the voice’s owner.

Trouble begins for Wataru during a visit from his paternal Uncle Lou when the two decide to investigate the abandoned building. After his uncle steps away to take a call, Wataru sees a golden door appear within the building, out from which steps Mitsuru. Both boys are shocked. Mitsuru immediately returns through the door, and Wataru attempts to follow him. Through the door, Wataru finds himself falling a great distance. He lands in a desert and shortly thereafter becomes surrounded by strange wolves with large, corkscrew mouths. He is saved by a wandering humanoid bird who reveals that he is known as a karulahkin and that the world they are in is known as Vision.

Our protagonist then awakens in the home of the building’s owner with his Uncle Lou at hand. When Lou attempts to take Wataru back to his hotel for the night, the boy forces out the truth: his father had called when they were in the building to inform Lou that he has decided to leave the household, divorce Wataru’s mother, and start a new life with an old lover. The entire family is devastated. Soon thereafter, Mitsuru goes missing, and Wataru overhears his mother gossiping about the murder-suicide of Mitsuru’s family by his father. That night, Wataru is awoken by the appearance of Mitsuru, dressed as a sorcerer, who explains that he has been chosen as a Traveler to journey through Vision in the hopes of meeting the Goddess of Destiny and changing his fate. He gives Wataru a pendant that should allow him to do the same once he travels through the gate in the abandoned building. Mitsuru then disappears, leaving Wataru to begin his adventure to Vision.

Once back in Vision, Wataru again meets the wizard, and he explains that Wataru must collect five gemstones and place them in hilt of this sword to gain access to the Tower of Destiny and meet the Goddess. On the way to the nearest town, he meets the lizardman Kee Keema who transports Wataru to the city, explaining the political situation of Vision along the way. The world is divided between those who believe in the Goddess and those who believe in the Old God, a deity purported to surpass the Goddess in every way. Followers of the latter are mainly ankha, what is known in the real world as human, and they espouse great intolerance to the world’s humanoid, animal inhabitants, known as beastkin. Kee Keema agrees to accompany Wataru on his journey. Over the course of the next few days, Wataru’s main party and alliances are established: Kee Keema and another beastkin named Meena will accompany him across Vision. As they get into various mishaps, the group encounters Mitsuru, now a powerful sorcerer with no concern for the death and destruction his magic causes. The boys come to learn that Vision is a reflection of their own imagination and understanding of life. It is further revealed that the appearance of two Travelers is an omen of a thousand-year sacrifice demanded by the Goddess: two people, one a citizen of Vision and the other a Traveler, are chosen to give their lives and act as the Barrier of Light to protect Vision and the real world.

A competition arises between the two boys from Japan, each thinking that the sacrifice will be the one who completes the journey last. Wataru is always one step behind Mitsuru in his collection of the gemstones, culminating in a final clash where Mitsuru destroys the entirety of an imperial capital, virtually eradicates all citizens, and unleashes a demon horde that had only been kept at bay by the final gemstone. Escaping the carnage, Wataru manages to gather four gemstones and is transported to the Tower of Destiny, the final trial from which only Wataru emerges alive. At the apex of the tower, he finally meets the Goddess. His wish is spent, not on himself, but on the salvation of Vision from the demon hordes. Returning to the real world, Wataru uses his knowledge and growth from Vision to handle the fallout of his home situation, supporting his mother as they transition into their new lives.

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