Summary:

This book is subtitled, "Toward a Psychology of Suffering." In the first chapter, Bakan sketches a theory of disease as telic decentralization. He defines "telos" as that which is "determinant of form." In multicellular organisms, there are multiple, subsidiary tele, as well as an overall telos of the organism. Growth and development can occur only if there is a certain degree of telic decentralization, yet disease can also result from this internal separation or estrangement. Bakan supports this theory with arguments from post-Darwinian evolutionary theory, Selye, and Freud.

In the second chapter, Bakan considers pain as the psychic manifestation of telic decentralization. Suffering is a pain-annihilation complex: the experience of pain external to the ego, associated with an internal fear of annihilation. In the last chapter, the author considers the Book of Job as a literary approach to understanding the meaning of pain, sacrifice, and suffering.

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This book contains the complete text of "Sakhalin Island" [300 pages], Chekhov's treatise describing his visit in 1890 to the Russian penal colonies on Sakhalin Island, and "Across Siberia" [30 pages], a description of his journey across Siberia to Sakhalin. The book also includes a collection of letters that Chekhov wrote during the seven-month trip. A series of appendices provide information on the Tsarist penal system, books consulted by Chekhov in preparation for his journey, and related matters.

Chekhov begins by describing his trip across the Tatar Strait on the steamer Baikal and his arrival at Alexandrovsk, the largest settlement and administrative center of Sakhalin Island. In the first two-thirds of the book, the author describes his systematic survey of almost every Russian community on the island. The text combines a travel narrative, which includes bits of conversations and fine descriptive writing, with demographic data.

At the time of Chekhov's visit, there were approximately 10,000 convicts and exiles living on the island, along smaller numbers of indigenous Gilyak and Ainu. Chekhov indicates the number of households and population of each settlement, and its breakdown by penal status of residents.

There were three categories of residents: (1) prisoners (some, but not all of whom were confined to the prisons that existed in the larger settlements); (2) settled-exiles, who had completed their prison terms but had to remain for life on Sakhalin; and (3) peasants-in-exile, who were permitted to leave Sakhalin, but had to remain in Siberia. Army folk and the families who accompanied some convicts to Sakhalin constituted a fourth class--they were free to return to European Russia.

Chekhov eloquently describes the poverty and terrible living conditions in this inhospitable land, as well as providing snippets of local geography and history. The final one third of the book consists of chapters on social and economic conditions, daily life, morality, and the health status of the population.

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Yalom begins her examination of the breast with the following statement: "I intend to make you think about women's breasts as you never have before." This she accomplishes by organizing the nine-chapter book around the following: (1) the sacred breast, (2) the erotic breast, (3) the domestic breast, (4) the political breast, (5) the psychological breast, (6) the commercialized breast, (7) the medical breast, (8) the liberated breast, and (9) the breast in crisis. Throughout the book, which covers twenty-five thousand years, she situates breasts' meanings as dependent on particular social, political, historical, and cultural phenomena.

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This history of western medicine in the nineteenth century chronicles the lives of some men and women who were innovators in the field of medicine. Williams begins the book in the 1700s with the life of John Hunter and his influence on nineteenth century medical practice and research.

The book consists of 16 chapters, many of which, like the one on Hunter are biographic. For example, Williams writes of the contributions, education, and lives of Florence Nightingale, Hugh Owen Thomas (orthopedics), Marie Curie, Joseph Lister, Ignaz Semmelweis (maternal health), Patrick Manson (tropical medicine), Jean-Martin Charcot, and William Conrad Röntgen. Other chapters are more theme-oriented, such as body-snatchers, discovery of anesthesia, homeopathic medicine, blood transfusion, and medical use of spas.

Black and white illustrations, such as Mrs. Röntgen's hand in an X-ray photograph help the reader to appreciate the advances in medical knowledge in the nineteenth century.

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This essay was written ten years after the author's Illness as Metaphor (see this database). Sontag begins by explaining the stimulus for her earlier essay: her own experience as a cancer patient. During that time, she discovered that cultural myths about cancer tended to isolate and estrange cancer patients. They suffered needlessly because of "meaning" attributed to their illness by society. A decade later, Sontag observes that attitudes about cancer have become more open and truthful. However, a new illness (AIDS) has arisen to carry forward the metaphorical banner.

AIDS brings together two powerful metaphors about illness. First, AIDS develops further the theme (seen earlier in cancer) of disease as invader: the enemy invades and destroys you from within. Thus, AIDS strengthens the use of military metaphors in medicine. The war against cancer is reincarnated as a war against AIDS. Secondly, because AIDS is a sexually transmitted disease, it also evokes the theme of plague-as-punishment.

Sontag's project in this essay is more focused than in the earlier book. She acknowledges that the medical and public health response to AIDS explicitly counters these myths. She concludes that "not all metaphors applied to illnesses and their treatment are equally unsavory and distorting" (p. 94). The metaphor she is most anxious to see eliminated is the military metaphor, both on an illness level (illness invades the person) and a societal level (social problems invade society).

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In this book written for the layman, linguist George Lakoff and philosopher Mark Johnson cogently argue that metaphor is integral, not peripheral to language and understanding. Furthermore, "metaphor is pervasive in everyday life, not just in language but in thought and action. Our ordinary conceptual system, in terms of which we both think and act, is fundamentally metaphorical in nature." (p. 3)

The authors adopt a broad definition of metaphor, examine common phrases for metaphorical interpretation, and offer a classification system of metaphor. For example, orientational metaphors are found in our ordinary language and are part of the spatial organization of our lives. When one says, "He dropped dead" or "He's at the peak of health," one is using the orientational metaphor that we live by: "Health and life are up; sickness and death are down." This orientation is not arbitrary; the authors point out that one lies down when one is ill.

Other types of metaphors categorized by the authors are structural and ontological (e.g., making a non-entity into an entity: "We need to combat inflation," or setting a boundary on a non-entity: "He's coming out of the coma"). The authors also differentiate metaphor from other figures of speech, such as metonymy, which relies more completely on substitution: "The ham sandwich wants his check."

The second half of the book address issues more philosophical in nature, such as theories of truth and how we understand the world, including the "myths" of "objectivism," "subjectivism," and "experientialism." These theories are reviewed with metaphor in mind. For example, objectivism relies on the separation of man from the environment and the subsequent mastery over the environment. Hence objectivism is rife with metaphors which confirm such ideas as "knowledge is power."

The authors conclude by stating that metaphors provide "the only ways to perceive and experience much of the world. Metaphor is as much a part of our functioning as our sense of touch, and as precious."

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William Morton first introduced ether anesthesia in 1846. This was followed shortly by nitrous oxide and chloroform. Within a few years, surgical anesthesia was being used throughout the United States. However, widespread acceptance did not mean universal usage. Physicians and surgeons debated the risks and benefits of anesthesia. Anesthesia was thought to be dangerous. Some argued that pain was a necessary part of life, that it made people stronger, and/or that it was a punishment from God. Others argued that anesthesia constituted an abuse of medical power.

Surgeons took care to select appropriate patients for anesthesia, while performing surgery without anesthetics on others. Women, people of higher social and economic classes, and people of the white race were thought to be more sensitive to pain than men, the poor, and Negroes and American Indians. Likewise, the young experienced pain more than the elderly. Certain procedures (e.g. major limb amputations and prolonged tissue dissection) were also thought to require more anesthetic than others (e.g. natural childbirth or ENT surgery). These beliefs carried over into practice, as evidenced by records from the Massachusetts General Hospital and other hospitals in the mid-19th century.

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In his study, Professor Starr examines the evolution of the practice and the culture of medicine in the United States from the end of the colonial period into the last quarter of the twentieth century. His major concerns are with the development of authority, and the Janus image of professionalization as medicine has gained power, technical expertise, and effective modes of diagnosis and treatment and at the same time seems to be getting further from the patient.

At the time of publication, our society had finally begun to take a hard look at the impracticality and the inhumanity of continuing on the trajectory of American medicine developed one hundred years ago. Starr invites the reader to consider the impact of modern stress on the profession and, more intently, on the constituency it is dedicated to serve.

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This study explores the history of physician-patient relationships, especially as it relates to the ascendancy of science in medicine. The book begins by describing traditional physician-patient relationships in the 18th century. The focus, however, is on the "modern" doctor (beginning in the 1880's) and the "postmodern" doctor (beginning in the 1950's).

The author describes the transition from modern to postmodern doctor and a corresponding transition from modern to postmodern patient. A "sympathetic alliance" between physician and patient was essentially a development of the modern period (1880's - 1950's).

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The writer, a comparative literature professor, elected to spend one full semester as an up-close observer in a medical school anatomy lab during the student dissection experience. He approached the experiment with the clearly articulated intention of writing about the lab, the instructors, the students, and their subjects. The book takes the reader dissection by dissection through the socialization process, as well as the technical content, of the class--from the first cut to the final memorial services for the cadavers at the closure of the term.

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