Summary:

Written with controlled elegance, this is an absorbing autobiographical account of psychiatric hospitalization. Twenty-five years after the fact, the author describes the two years during her late adolescence in which she "slip[ped] into a parallel universe." The surreal nature of the experience is reflected in darkly comedic recollections of her inner life, the other patients, their families, the staff, and of forays into the outside world.

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This documentary, narrated alternately by the daughter-filmmaker and mother whose stories it tells, focuses on how two women move apart and together while experiencing, respectively, adolescence and mid-life. The mother has cancer, a mastectomy, and then rheumatoid arthritis, and these experiences intertwine thematically and structurally with the narrative of the mother-daughter relationship.

Another provocative juxtaposition cross-cuts scenes from the daughter's modeling career (and the social and erotic body that context constructs for her) with scenes of the mother's illness, stigmatization, and erotic daydreams. Both women come to a new awareness of the social meaning of mastectomy within heterosexual and same-sex contexts by the documentary's end; they also come to a place of recognition of the mother's personal and social value and the nature of their relationship.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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This documentary video follows the making of an opera, based on the illness experiences of four Australians who have been diagnosed and treated for cancer. Their feelings about these experiences are translated into music (with lyrics) as they work closely with music therapist/composer, Emma O'Brien. As the three women and one man tell their stories of physical debility and emotional pain, the music therapist asks them to think in terms of color (they choose purple, black) and tones and rhythms that she plays for them on the piano.

When the narratives and their musical representations have evolved sufficiently, trained singers take on the roles "written" for them by the four former patients; the latter continue to be intimately involved in the opera's production, directed by David Kram. At the end of the project, which is also the conclusion of the film, the opera is performed in front of an audience (with musicians playing instruments, singing, and dramatic enactment) and the four people whose illness experience is performed take their bows together with the singers.

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A poem of five sonnets reflecting on the poet's discovery of an asymmetry in his breasts requiring a mammogram. The resultant diagnosis, gynecomastia, is the source of flippant "nervous humor," as McClatchy describes it in a section on the authors and their poems at the end of this anthology (pg. 265), followed at the end of the poem by a "darker, more serious meditation" (again in the poet's own words). The meditation is not so dark or abrupt that it undermines the poem's integrity.

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The documentary film opens with the filmmaker, Susan Smiley, in search of her mother, Millie, who suffers from paranoid schizophrenia and who, once again, has disappeared into the woefully inadequate public health care system of middle America. Through old photographs and home movies, interviews with family members and health care professionals, and voice-over and direct narration by Smiley herself, the film chronicles the descent of a young, beautiful woman in her twenties into severe and chronic mental illness.

When Millie’s marriage to their father fails, Susan and her younger sister, Tina, are essentially abandoned to endure severe physical and emotional abuse by their mother. As the years unfold, Millie eventually loses her home and embarks on a journey of evictions, arrests, hospitalizations, and homelessness. At what seems to be Millie’s lowest point, warehoused in a nursing home where she is angrily refusing to take any medication, her daughters intervene, petition for guardianship, and navigate the system on behalf of their mother.

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At 23 years old, James is brought by his parents to a drug and alcohol rehabilitation center in Minnesota to get treatment for his alcoholism and drug addictions. Physically and emotionally shattered, he slowly recuperates, sometimes insistently conquering his addictions with his own willpower, and at other times with the help of those around him. The consequences of his addictions, his struggle against the platitudes of the Twelve Step programs, and his relationships with his counselors build the tension in the book; his relationship with his family and several of his fellow addicts forms the heart of it.

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In three sections of remarkable narrative poems, Fraser reviews how his own and his family's lives are utterly changed by the birth of his youngest brother, Jonathan, who is profoundly disabled by spina bifida and has survived into adulthood--long beyond what doctors predicted. An introduction provides the context: the poems chronicle a hard journey from denial, shame, and anger to acceptance. As Fraser writes toward the end of the final, title poem: "We must learn to cherish chance to have one." But chance has dealt his brother, and so his family, a particularly hard blow.

The first section focuses primarily on his own remembered reactions and reflections--his guilt, his cluelessness--as a child and adolescent; the second on relationships with family and friends as an adult, all of them partly shaped and shaded by the ongoing suffering of his disabled brother; the third and longest, an exercise in empathy-with his mother and with Jonathan, neither of whose suffering, he realizes, is entirely imaginable to him. The poems are regular free verse, rich with allusion, emotional precision, and narrative detail.

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This collection traces the writer/speaker's journey through her husband's diagnosis to his death of cancer and through the first year after loss, ending with an eight-part poem entitled "The First Yahrzeit," (69) that commemorates the one-year anniversary of her husband's death. The poems vary richly in tone, structure, and focus, some vividly descriptive of the experience, some obliquely figurative, some simple pauses over a moment or an object that has become evocative or sacralized in the course of mourning. Every one offers a surprise line or image that is worth returning to. The whole chronicles a journey of a kind many have had to take, and offers a testimony of hard-won, ambiguous healing.

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A four sonnet sequence that pulses with Hacker's witty rhyming and half-rhyming, taking place late at night with the threat of a migraine, the repetitive frustrations of insomnia and memories of the "lie" that ended a relationship. The warning of wildness and danger ("A lie hung framed in the doorway, growing wild") running through the poem is held in tentative check by the sonnet form and the repetition of the last line of the previous sonnet as the first line of the next (a technique neatly described in the poem itself: "The double doors close back upon themselves. / The double doors close back upon themselves.")

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