Summary:

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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This short poem is about work--all kinds of work--and what it takes out of us--physically, emotionally, spiritually: "All the work / that makes love difficult . . . that reaches the intestines and sprawls."

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Leland Fowler, a small-town Vermont attorney, is raising his small daughter alone two years after his wife's death in a car accident when he meets Carissa Lake, a homeopath, and falls in love. He originally seeks her services because of low-grade cold symptoms that won't go away. She attempts to keep their relationship purely professional, but finally advises him to see another homeopath so they can pursue a more intimate relationship.

She starts him on a regimen of highly dilute arsenic solution that helps him immediately. In the meantime another patient of Carissa's, a young family man suffering from severe athsma and allergies, has gone into a coma as a result of eating cashews to which he is violently allergic. The man's wife brings legal action against Carissa since it was under her care that Richard, the patient, started taking a homeopathic solution derived from cashews and apparently was motivated to try the cashews themselves by dint of misunderstanding the "law of similars"--that "like cures like"--that is a central homeopathic principle.

Leland's law firm prosecutes after Richard dies, and Leland is forced to keep his relationship to Carissa secret while he himself struggles with his own doubts about homeopathy. To protect Carissa, because he believes her innocent, he helps her doctor her casenotes. Eventually the case is dropped; Carissa leaves town; and Leland is left to ponder the forces that drive medical, legal, and personal decisions.

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This is a harrowing story, told in the first person, of an obsession with food and body image. "One day I will be thin enough", says Josie, the 25 year old anorectic woman who has been hospitalized for life-threatening self-starvation. "Just the bones, . . . the pure, clear shape of me." "One day I will be pure consciousness." The narration spins out in painful detail the pattern of compulsive behavior which pervades Josie’s existence. Her pitifully barren emotional life is revealed as well.

How did it all begin? Flashbacks of significant events invade Josie’s attempts to stop thinking. A shy, awkward adolescent, overly sensitive to casual comments about excess flesh, decides to diet. Josie stumbles non-communicatively through a teen-age sexual initiation to a later affair with her married professor, retreating ever further from her bewildered family.

But why do events take such an extreme turn? The mystery of anorexia nervosa remains. In the hospital, a nurse who has seen everything seems to strike some responsive cord, and Josie begins eating to gain weight. At the end of the novel she’ll soon be released , under supervision, but the outcome is in doubt. "Can I learn to be so present? Can I learn to be so full?" ". . . if I were a body, what would I be?"

 

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Shortly after the American Civil War, neurologist S. (Silas) Weir Mitchell became interested in a certain group of women, whom he describes as "of a class well known to every physician,--nervous women, who, as a rule, are thin and lack blood." Mitchell’s basic premise was that these women, largely between the ages of 20 and 30, have lost their vitality as a result of some form of prolonged strain--which has caused them to become thin, of insufficient blood, and unable to perform their regular duties.

In his long essay, essentially a compilation of case studies, he further characterizes these patients and outlines the treatment which he found to be unfailingly successful in returning them to normal activity. The treatment he utilized had the following essentials: seclusion and rest; massage; electric stimulation, a high-fat and high-calorie diet. His patients were not allowed to see their families, nor to read, write or otherwise strain themselves. The average duration of therapy was six weeks, usually carried out in an institution or private retreat.

Of interest is the single male who Mitchell felt met the criteria for his treatment plan. This patient, who had some (to the modern reader) lung findings suggestive of tuberculosis, allegedly was cured after three months of bed rest and frequent feedings.

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A junior doctor goes to visit the daughter of a wealthy factory owner. (The professor was too busy to go.) The daughter had been ill for a long time and had just suffered "heart palpitations" the previous night. At first the doctor finds nothing wrong with her heart, and says that her "nerves must have been playing pranks" on her.

The patient’s family presses the doctor to stay for the night. During the evening, he reflects on the oppression of the dreary factory town and relates the sense of loneliness and confinement ("like a prison") to his patient’s condition. Later, in conversing with the young woman, he actually listens to her empathically, rather than just focusing on her symptoms or the function of her heart. He is then able to respond empathically to the young woman’s plight.

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James Norton travels from Boston to Paris at his domineering mother's urging to bring home his fragile sister, Ellie, and their journalist brother, Rafael. He discovers Rafael devastated by the death of his Jewish lover, Olympe. Suicide, accident, or murder? Ellie is confined to a wheelchair owing to an unexplained paralysis. James is drawn into finding solutions to both problems and his investigations lead him to seedy brothels, the bureau of a hypnotist, the morgue of aspiring neurologists, and the wards of la Salpetrière, the famous neuropsychiatric hospital for women. The autopsy reveals that Olympe had been pregnant and the questions about her death multiply. The exoneration and return to France of Dreyfus plays as a backdrop.

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When a wealthy man falls victim to incapacitating attacks of vertigo, a young doctor decides that the problem and solution both reside in the patient's head. Gierke is an eccentric widower in his forties who remarries. While honeymooning in Italy with his 17-year-old bride, he collapses after looking down from the heights of a bell tower. Gierke becomes paralyzed by a fear of future attacks of vertigo and eventually stops walking.

Multiple physicians evaluate him without success. Finally a neurologist, Dr. Hugo Spitz, is consulted. He wants to try psychoanalysis but the patient has become extremely introverted. Spitz interviews all Gierke's relatives and even hires private investigators. The doctor devises a theory that Gierke murdered his first wife by pushing her off a mountain and then inherited her fortune.

Spitz reasons that Gierke's vertigo is the result of repressed feelings of fear and guilt. After confronting Gierke with the explanation, Spitz orders his patient to stand. Gierke walks without experiencing any dizziness. Immediately after the doctor exits the house, there is a loud sound and Gierke's dead body, fractured in multiple places from a fall, is found at the bottom of the staircase. Spitz deduces it was suicide.

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This book contains six medical case studies in which hope, or lack of it, played a role in the outcome. Five stories are of Groopman's cancer patients, the sixth the story of his own recovery from severe chronic lower back pain. The book concludes with an account of Groopman's search for scientific answers to the questions that inspired the book: How is the cognitive-emotional complex of hope formed in the mind? How might that complex affect the chemistry of the brain? And how might that, in turn, affect the physiology of the body in a way that would be relevant to healing?

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In four lengthy chapters, the biographies of Haydn, Mozart, Beethoven, and Schubert are carefully presented. Special attention is given to health, both physical and psychological, throughout life and at its end. Autopsy information is included. In particular, the author emphasizes the impact of illness on the composers' relationships with family members and doctors, and on their musical composition.

Evidence is derived from a wealth of primary sources, often with long citations from letters, poetry, musical scores, prescriptions, diaries, the remarkable "chat books" of Beethoven. Neumayr also takes on the host of other medical biographers who have preceded him in trying to retrospectively 'diagnose' these immortal dead.

Late eighteenth- and early nineteenth-century Vienna emerges as a remarkable city of musical innovation and clinical medicine. The composers' encounters with each other link these biographies. Similarly, many patrons, be they aristocrats or physicians, appear in more than one chapter, such as the Esterhazy family and Dr Anton Mesmer.

The disease concepts of the era, prevalent infections, and preferred therapies are treated with respect. Rigid public health rules in Vienna concerning burial practices meant that ceremonies could not take place in cemeteries and may explain why some unusual information is available and why other seemingly simple facts are lost.

Biographical information about the treating physicians is also given, together with a bibliography of secondary sources, and an index of specific works of music cited.

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