Summary:

Suzanne Poirier has studied over 40 book-length memoirs describing medical training in the United States. These texts vary in format from published books to internet blogs, in time (ranging from 1965 to 2005), and in immediacy, some reporting during medical school or residency while others were written later--sometimes many years later.

A literary scholar and cultural critic, Poirier analyzes these texts thematically and stylistically, finding pervasive and regrettable (even tragic) weaknesses in medical education. Her three major points are these: such training (1) ignores the embodiment of future doctors, (2) is insensitive to the power relationships that oppress them, and (3) makes it difficult to create a nurturing relationship--especially by tacitly promoting the image of the lone, heroic physician.

While some of these repressive features have improved in the last decade or so--in contrast to the momentous scientific progress--there is a general failure to deal with the emotional needs of persons in training as they confront difficult patients, brutal work schedules, and mortality, both in others and in themselves.

In her conclusion, Poirier describes some contemporary efforts to help medical students write about their feelings, but she also sees the negative consequences of "an educational environrment that is inherently hostile to such exercises" (169).  Her challenge is this: " "Emotional honesty is a project for all health professionals, administrators, and professional leaders" (170).

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This book in large-format (11 1/8  x  8 3/4 in.) is made up primarily of wonderful illustrations but there is also clear and clever text; both media clearly explain the structures and systems of the human body.  Although nominally listed as “Juvenile Literature,” The Way We Work is sophisticated and detailed enough to educate and entertain adult readers, without losing the interest of intelligent young readers.

The drawings, in pencil and watercolor, are dazzling: large, colorful, with a variety of layouts and perspectives. Many go across double-page spreads, and many include a witty image of one or more small observers. In “Mapping the Cortex,” for example (pp. 158-159), an enormous, multicolored brain takes up most of two pages; it is partially exploded into 11 areas, labeled by name and function, and coded (sensory, motor, or association). A tiny (one-inch) man below with a question mark over his head looks at a dangling rope (I think) hanging from the brain. A small text block fits in the lower left-hand corner.

The book is organized by seven chapters, each for a body system, such as “Let’s Eat” (digestive system), “Who’s in Charge Here?” (nervous system), and “Battle Stations” (immune system). While the parts of the body (anatomy) are clearly shown, the book stresses biological process (physiology), truly “the way we work,” and in considerable detail. In “Let’s Eat,” for example, there are 50 pages, starting from what foods we eat, our sense of smell, taste receptors, teeth, chewing muscles, salivary glands and saliva, the entire alimentary canal, including biochemical and molecular activity, the roles of pancreas, liver, and kidney, and urinary and fecal outputs.

Children of all ages will enjoy “Journey’s End,” which shows a gigantic rectum miraculously suspended over a cityscape, with dump trucks arriving below it to receive stupendous loads.  Indeed, there is much humor in the book, both in the drawings and in the text blocks. 

 

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This is another wonderful book from Dr. Sacks. The subtitle, “Tales of Music and the Brain,” is accurate: we have a charming and informative mixture of stories of patients and the neurophysiology that interprets how music is processed and performed. The book is synthetic in combining cases from his practice, other clinical reports, letters from correspondents, references to medical literature, and even Sacks’s own personal experiences with music.

Sacks finds that humans have a “propensity to music,” something “innate” in human nature, perhaps like E. O. Wilson’s biophilia. “Our auditory systems, our nervous systems,” he writes, “are indeed exquisitely tuned for music” (xi). Although humans have been involved with music for millennia, it is only in the last few decades that medical imaging (functional MRI, PET) has shown what areas of the brain are active when music is heard.

While humans routinely enjoy music, the book emphasizes unusual events and neurological patients, in short, departures from the norm. Sacks—himself a lover of music—reports on his own experiences with hallucinatory music and anhedonia (loss of pleasure) in hearing music. He describes going to hear the great baritone Dietrich Fischer-Dieskau but finding that he could not, on that day, perceive the beauty of the music. Another condition “amusia,” or loss of musical ability, can be chronic, acquired, or temporary.

Some patients have had injuries or diseases of the brain that change how music is perceived. A man hit by lightning is suddenly obsessed with piano music. Another man (who survived a brain infection) has amnesia about many things but can still make and conduct music at a professional level. The concert pianist Leon Fleisher visits Sacks to discuss his dystonia, or loss of muscle function in one hand (with implications for the brain). Rolfing and Botox helped him heal and he returned to two-handed performances.

Sacks discusses other phenomena that involve brain structures, for example, perfect pitch; persons with this ability have “exaggerated asymmetry between the volumes of the right and left planum temporale” (128). People who experience synesthesia (perceiving notes as colors) have cross activation of neurons in different areas of the brain. Professional musicians (and patients with Tourette’s) demonstrate cortical plasticity, that is they have expanded areas of the brain for particular uses. Children with Williams syndrome have brains influenced by a microdeletion of genes on one chromosome; they have some cognitive deficits and also a great responsiveness to music. For some conditions, the brain determines all; for others, behavior components are also important.

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Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).

The book is divided into Introduction, five chapters on specific memoirs, and Conclusion. Chapter 1, "Patients and Biopower: Disciplined Bodies, Regularized Populations, and Subjugated Knowledges," draws on Foucault's theory of power to discuss two mid-20th-century memoirs of institutionalization for tuberculosis. Betty McDonald's the Plague and I is compared with Madonna Swan: A Lakota Woman's Story. Dividing practices and regularization are shown to serve different functions in these two incarcerations, figurative in the case of Betty McDonald, and literal in the case of Madonna Swan.

Chapter 2, "Politicizing Patienthood: Ideas, Experience and Affect," draws on Foucault's approach to the subject and on his discussion of "practices of the self" in contrasting Audre Lorde's The Cancer Journals with Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (see annotations). Diedrich also brings into her analysis Eve Sedgwick's theory of queer performativity and Sedgwick's own illness narrative, White Glasses. Diedrich views all of these as counter narratives to the clinical medical narrative of illness but she shows how they differ in stance.

Chapter 3, "Stories For and against the Self: Breast Cancer Narratives from the United States and Britain" looks at "the arts of being ill" as they are represented in two cultures, two "conceptions of the self in these countries at a particular historical moment" (61). The narratives discussed are Sandra Butler and Barbara Rosenblum's narrative, Cancer in Two Voices and Ruth Picardie's Before I Say Goodbye (see annotations). Diedrich associates Cancer in Two Voices with an American notion of self-improvement and Before I Say Goodbye with a British "emphasis on the cultivation of an ironic self" (55). The author works in this chapter with Freud's idea of the uncanny, Benedict Anderson's concept of "imagined political communities" and Elaine Scarry's discussion of pain, language, and the unmaking of the self.

Chapter 4, "Becoming-Patient: Negotiating Healing, Desire, and Belonging in Doctors' Narratives," treats Oliver Sacks's illness narrative, A Leg to Stand On, Abraham Verghese's autobiographical My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS, and Rafael Campo's book of essays, The Poetry of Healing (see annotations). Here Diedrich considers "the possibility that doctors, especially AIDS doctors, might become patients through desiring-and writing-productions" (83) and she utilizes the rhizome model of Deleuze and Guattari to make her case. She discusses how Verghese and Campo are each both cultural insiders and outsiders and how they each "bring the body into language through their writing" (88).

Chapter 5, "Between Two Deaths: Practices of Witnessing," focuses primarily on Paul Monette's writing about the loss of his partner to AIDS, and on John Oliver Bayley's books about the loss of his wife, Iris Murdoch, to Alzheimer's, and her ultimate death (see annotations in this database). In this chapter Diedrich invokes Lacan's concept of the real and his formulation of "the ethical possibility of being between two deaths" (117). She draws also on trauma theory and the work of Kelly Oliver, a contemporary feminist philosopher who has written on witnessing.

Finally, in her "Conclusion: Toward an Ethics of Failure," Diedrich returns to Elaine Scarry's "phenomenological discussion of the experience of pain" and brings in Jean-François Lyotard's concept of incommensurability and his suggestion between the two poles of what is seemingly incommensurable one might search, in Diedrich's words, for "new rules for forming and linking phrases between . . . subject positions" (150). In that context she analyzes physician Atul Gawande's discussion of medical uncertainty and error in his book, Complications (see annotation) and philosopher Gillian Rose's book, Love' s Work. Diedrich concludes that the basic incommensurability between doctor and patient can be a starting point for a new ethics, an ethics of failure and risk "because by taking such risks [of failure, of relations], we open up the possibility of new routes, new treatments: in and between art, medicine, philosophy, and politics" (166).

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In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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Oschman, a former cell biology researcher, applies his scientific training to the emerging field of energy medicine. While previous investigators (Franz Anton Mesmer, Guillaume Benjamin Armand Duchenne, Edwin D. Babbitt, Harold Saxon Burr) were either ignored or selectively accepted, healers from ancient times have used touch to heal or even cure the human body, and the human body itself has sophisticated strategies to heal itself.

Oschman shows how the body is a living crystal with electricity, magnetism, and light flowing through it, often at higher speeds than the standard neurology model. Quantum physics applies here, as well as piezoelectricity (pressure electricity), explaining how energy flows through water molecules in the collagen that invests every internal structure of the body. Proteins in the body are semiconductors, and our brain waves may even be tuned to standing energy waves (Schumann resonance) that surround the earth itself.

Oschman collects data and illustrations widely, from acupuncture, Qi Gong, massage, yoga, meditation, Zen, and of course, standard medicine. The latter, he argues, whether through scalpels or pharmaceuticals, can be understood as energy medicine. Even better, in his point of view, would be an imaginative synthesis of standard medicine with many (other) forms of energy medicine.

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As an anthropologist with training in comparative biology, Jablonski is particularly interested in the natural history of humans: how did humans evolve to gain the varied appearances we see today? In particular, she investigates how our skin developed into a covering that is unique among animals in three ways: (1) it is naked--effectively hairless--and sweaty, (2) we come in a wide array of colors (not just the traditional four), and (3) we use our skin as a surface for decoration, a "social placard," which we cover or bare at will, and on which we put make-up, tattooes, scarifications, and piercings, all ways of expressing cultural and personal values.

Our ability to sweat allowed us to cast off the usual mammalian fur coat and to be active even in the heat of the day (when many creatures take shelter). Humans, therefore, could do more and be more as thinkers, builders, and social creatures.

As to our color variations, Jablonski argues that the main root of modern humans came out of East Africa; these people were black, because a lot of melanin in their skin was the best way to avoid too much ultraviolet radiation, although some is needed to create Vitamin D. As humans migrated to the north and the south, Darwinian selection favored lighter skin pigmentation in order to use the lower levels of sunlight.

Jablonski writes, "Dark skin or light skin, therefore, tells us about the nature of the past environments in which people lived, but skin color itself is useless as a marker of racial identity" (p. 95). And, noting an irony: "Naturally dark people in many parts of the world are increasingly seeking ways to lighten their skin, while the naturally light-skinned are trying to find new ways to darken theirs" (p. 159).

We often take our skin and all its functions for granted; our consciousness can change quickly, however, if we experience a skin disease, a sunburn, or a thermal burn (see Carter and Petro, Rising from the Flames: The Experience of the Severely Burned). Jablonski discusses a variety of illnesses, including burns, dermatitis, and skin cancers. Other topics include the importance of touch, how skin relates to emotion and sex, and experiments in artificial skin, useful for covering patients with severe burns.

Jablonski presents a dozen color plates, 44 figures, and maps to enliven her text.

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The book opens with a thought "exercise": thirteen short essays, each in a different national voice and beginning "We, the people of a nation . . . " The honest, intelligent "speakers" love their countries and traditions; however, they try to express the ugly truths about their homelands as challenges for the future.

For example, American smugness over its know-how and wealth combines with American failure to recognize the resentment sparked elsewhere by these same attributes. Similarly, the mutual intolerance of Canada's linguistic and religious duality is portrayed as a grotesque irony. The U.S.S.R. has exchanged an old tyranny for a new; Japan must face the issue of controlling its population, if it is to control its impulse to aggression.

Chisholm then returns to his role as a socially committed psychiatrist who hopes to avert a war that could annihilate the human species. World aggression, he writes, is caused by the "anxiety" that emerges from intolerance typifying narrow parental guidance and even narrower systems of education and religion. People must learn to be comfortable with differences in population, race, language, and wealth. The message is simple: "anxiety" leads to "aggression." The book ends with a ideal curriculum for "world citizenship," surprisingly different from any currently in use.

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In a fascinating and wide-ranging series of chapters organized by categories of disease or disability that have afflicted known artists, writers, and musicians, Sandblom examines the multifaceted relationship between creative work and illness. He begins his discussions of particular artists usually with basic information about the nature of the affliction and its manifestations; where available, introduces the artist’s own comments upon his or her condition; and then analyzes how particular works represent or implicitly allude to the illness. In some cases the disease is a context; in others a theme; in others a vehicle or tenor of metaphor.

The book is richly illustrated with reproductions of paintings, parts of musical scores, and poems or prose excerpts. Artists and writers under discussion include Bacon, Beethoven, Jorge Luis Borges, the Brontes, George Gordon Byron, Cezanne, Anton P.Chekhov, Chopin, Emily Dickinson, F. (Francis) Scott Fitzgerald, Johann Wolfgang von Goethe, Nathaniel Hawthorne, Franz Kafka, John Keats, Mahler, Thomas Mann, Herman Melville, John Milton, Flannery O’Connor, Proust, Rainer Maria Rilke, William Shakespeare, Robert Louis Stevenson, Titian, John Updike, William Wordsworth, and Yeats, to name a few.

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Yoshino has written a book that is both treatise and memoir. Taking his cue from Erving Goffman's introduction of the term "covering" (in Stigma: Notes on the Management of Spoiled Identity), Yoshino writes from his own experience as a young gay Japanese American who is also a lawyer and scholar at Yale University. Covering, Yoshino proposes, is "to tone down a disfavored identity to fit into the mainstream" (ix). He identifies three historical and individual stages of dealing with disfavored identity: conversion, in which the individual and/or society try to transform an identity to render it more acceptable (for example, attempts to convert homosexuals into heterosexuals); passing, in which the individual hides the undesirable identity to a greater or lesser extent depending on circumstances; and covering, in which the individual openly acknowledges the undesirable identity but suppresses behavioral aspects of the identity that could draw unwelcome attention (for example, a gay male publicly holding hands with or kissing another gay male).

The author discusses these concepts specifically with relevance to his gay identity in part one of the book, detailing how he went through these three phases himself. Part two elaborates on racial and sex-based covering, and part three discusses Civil Rights and legal issues that surround covering. Yoshino argues that contemporary American society imposes covering on certain groups--gays, blacks, women, disabled people, Jews, Asian Americans--and ultimately in some manner on everyone. The bases for this imposition are pressures to conform and to assimilate. He identifies "covering axes: appearance ( . . . 'I own brown suede bucks'); affiliation ('I listen to National Public Radio . . . '); activism ('I do not mind how white television casts are . . . '); and association (' . . . I married a white woman')" (125).

Beyond that, according to the author, our laws and their interpretation by the Supreme Court "instruct the mainstream to ignore [difference] and the outsider group to mute it" (182). This is an inevitable result of the great pluralism of contemporary society--the courts cannot protect all separate groups that exist.

In the final chapter Yoshino proposes a new paradigm for Civil Rights: universal liberty (rather than equality among groups) based on "our common humanity." This paradigm would allow individuals to live "authentically" and in good psychological health. Yoshino invokes the concept of health proposed by theorist, D. W. Winnicott: living according to one's "True Self" while the "False Self" "is reduced to a 'polite and mannered social attitude,' a tool available to the fully realized True Self" (185).

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