Summary:

This is the wrenching history of the development, evolution, and eventual obsolescence of the leper colony established in 1866 on the isolated and only sometimes accessible peninsula on the Hawaiian island of Molokai--and the lives of the people who were exiled there to die over a period of more than 100 years. The tale opens with the declaration by the Board of Health that all persons proven (or strongly suggested) to be afflicted with leprosy be exiled immediately to the site on Molokai.

The author dramatically describes the selection and separation of the exiles from their families and the tortuous and sometimes deadly sea voyage to their primitive new homeland. Mixed with the public policy and the individuals who made and implemented it, are the descriptions of the hospital in Honolulu where diagnoses and dispositions were rendered, as well as the poignant personal stories of the "detainees." The reader follows the colony from the arrival of its first 13 patients in 1866, through its peak population of 1,144, to its residual 28 in 2003.

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Louis Drax is a nine-year-old boy living in France with his stay at home mother and Air France pilot father. Such an apparently normal family description is the merest tissue of appearances. The father is probably an alcoholic and unfaithful; the son is "accident-prone" (a nearly fatal episode of SIDS at two weeks of age, a near fatal electrocution at age 6 after falling on the tracks of the métro in Lyon; salmonella, tetanus, botulism, meningitis, etc. [or, as Louis is fond of saying, "blah, blah, blah."]) and the mother has issues that only emerge as one becomes more deeply involved in what is a mystery story.

Like Gabriel Garcia Marquez’s A Chronicle of a Death Foretold, or Janet Lewis’s superb The Trial of Søren Qvist, one knows the ending early on (page 16 in Louis Drax), but not the details. The why and the how are the stuff of the novelist’s art in all three books.

With premonition of more danger, Louis goes on a family picnic (see below for the author’s biographical basis for this tale) and winds up at the bottom of a ravine, dead. Drowned and dead. A few hours later, in the morgue, he is found to be alive. Comatose and in a persistent vegetative state but alive. He is therefore transferred to the care of a neurologist specializing in comatose patients at the Clinique de l’Horizon (formerly l’Hôpital des Incurables).

It is here that the mystery unfolds. The questions are: How did Louis end up at the bottom of the ravine? Did his father, now missing, push him as his distraught mother alleges? What role does the clearly neurotic mother play in this tragedy? And who exactly is Louis Drax? Lastly, how do the mysterious letters allegedly from him, written while still in a coma, come to be?

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This volume belongs in the category of cross-cultural studies of medicine and the humanities. Its main audience is scholars of nineteenth-century American psychiatry and culture. The author divides his study into six chapters, each with a topic, including the simultaneous emergence of nineteenth-century public debate about improving the treatment of insanity and the movement to abolish slavery; cultural activities in asylums directed toward humanizing the patients; bardolatry in British and American medical circles; discussions of Emerson, Hawthorne, Poe, and Melville in the context of their literary and personal relationship with madness; a chapter on captivity narratives and popular novels by former female and male patients; and an epilogue.

Unlike today, "In mid-nineteenth-century America, the condition of the mentally ill seemed to demand-and to a large degree received-national attention and the full creative energy of a group of dedicated reformers" (p. 2). Reformers linked the emancipation of slaves with curing the delusions of the insane. Slaves and the mentally ill had in common deprivation of their civil liberties; however, the difference was that white mental patients could be expected to grow up eventually, whereas black slaves would always remain children, and hence could not be trusted with the right to vote, own property, or sign contracts.Some causes of insanity were deemed to be the individual's reaction to the stress of modern life, too much freedom and choice, religious fervor, masturbation, or excessive study. In their aggressive attempts to remake patients into proper gentlemen and ladies, the new asylums promoted cultural activities such as reading selected texts, theater performances and writing.

Most asylums housed males and females in approximately equal numbers; cultural activities for females stressed piety, fashion, and domestic activity while men could comment on politics, the temperance movement, and opposition to women's rights. Reiss refers to the French model of using cultural activities in asylums, f.ex., Philippe Pinel's staging of plays to educate patients, and Marquis de Sade's theater performances at Charenton. He ends with a discussion of patient narratives that depict some horrific abuses tolerated in nineteenth-century asylums; the degree of these abuses is familiar to us from One Flew Over the Cuckoo's Nest (see film annotation).

The work includes a few illustrations, the most important being an engraving from a painting by Tony Robert-Fleury titled: Pinel Freeing the Insane (1876). (Yale University). Philippe Pinel (1745-1826) was a French pioneer in the humane treatment of mentally ill patients. A Director of Bicêtre Hospital in Paris, he is depicted as a heroic physician, liberating, mostly female, patients there. However, scholars have shown that only 10 of the 270 patients were chained, and that Pinel '"accepted the traditional use of chains to restrain the violent insane as a matter of course"' (p. 160). Reiss's point is that the revolutionary nature of Pinel's treatment of the insane has been exaggerated.

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The index finger of his left hand touching the thumb of his right, the young Jesus sadly debates a mob of arrogant, self-righteous scholars. The mood is ominous. The doctors are challenging him, thrusting their sacrosanct doctrines at the fresh pure voice of the youth. They are so cemented into dogma that Jesus's moral and ethical message is an affront to their hard-held authority. Citing their previous books as "gospel," they have completely ignored his message--that one must live by the spirit, rather than the letter of the law.

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Written by a psychiatrist and historian, American Melancholy: Constructions of Depression in the Twentieth Century looks at how culture, politics and, in particular, gender have played a role in the development of a diagnosis.  Hirshbein moves between several different worlds, showing how they intercalate and, indeed, are very much part of the same world: psychiatric nosology and cultural attitudes to the gendered expression of emotion and feelings, medication trials and magazine advice to women about how they should deal with the blues, the relations between treatment paradigms and how society views suffering.

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Baiev’s chronicle of medical life in wartime is full of incident—tragic, touching, and repeatedly traumatic:  his own life was threatened repeatedly by Russians who suspected him and Chechens who resented him for treating Russians.  Members of his extended family were killed and his father’s home was destroyed.  He straddled other boundaries:  trained in Russia, he fully appreciated how modern medicine may bring relief not available even in the hands of the most respected traditional healers, but he mentions traditional ways with the reverence of a good son of devout Muslims.  His perspective is both thoughtfully nationalistic and international.

Finally coming to the States where he couldn’t at first practice the medicine he had honed to exceptional versatility under fire, he lives with a mix of gratitude for the privilege of safety and a longing for the people he served, whose suffering was his daily work for years that might for most of us have seemed nearly unlivable.  Before writing the book, he struggled with his own post-traumatic stress, and continues to testify to the futility of force as a way of settling disputes.  Medicine is his diplomacy as well as his gift to his own people, and the Hippocratic Oath a commitment that sustained him in the midst of ethical complexities unlike any one would be likely to face in peacetime practice.

 

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Titicut Follies is the first major, full-length documentary by Frederick Wiseman, generally considered to be the most successful independent filmmaker in the United States.  Titicut Follies (the title of the film is taken from an annual talent show produced by inmates and staff) was filmed at the Massachusetts Correctional Institution in Bridgewater, Massachusetts, a sprawling facility of four divisions with four distinct populations.  Of the two thousand men warehoused there in the 1960s, only fifteen percent had ever been convicted of a crime, yet the institution was administered by the Department of Corrections rather than the Department of Mental Health--units representing very different and contradictory goals.  At the time of the filming, there were only two psychiatrists and one trainee caring for the six hundred men in the hospital section. 

Wiseman believed that public awareness of the terrible conditions at Bridgewater would create a demand for reform and improvement, and he gained unlimited access to the facility by representing the project to administration and staff as educational.   The result is a bitterly critical, shockingly brutal documentary account of the prison hospital, and despite giving Wiseman permission to make the film, the Commonwealth of Massachusetts quickly moved to ban its release.  In September 1967, just days before it was scheduled to be screened at the New York Film Festival, the attorney general filed an injunction that would permanently forbid Wiseman from showing the documentary to any audience.  In 1969, the Massachusetts Supreme Court permitted limited use for doctors, lawyers, health-care professionals, social workers and students, and in 1991, the courts finally allowed its release to the general public.  Titicut Follies is the only American film whose use has had court-imposed restrictions for reasons other than obscenity or national security.

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South Africans, Paul and Andrea, are lovers living in France. Paul is fiftyish and white; Andrea is thirty and “coloured.” He has just asked her to marry him. She travels to Provence ostensibly to research sites for a film to be based on Paul’s endlessly forthcoming novel about fourteenth-century plague. But the real reason for the journey is to test her feelings about his proposal—she is leaning to ‘yes.’

As five days roll by, she relives the trajectory of her life: her impoverished parents, her thwarted education, her angry, imprisoned brother, and the previous affair with Brian, a British historian with whom she was captured ‘in flagrante,’ sent to trial, found guilty, and offered prison or voluntary exile. Brian and Andrea left South Africa together, but their relationship eventually crumbled. She had trouble understanding his passion for the past and his love of detail.

In Provence, Andrea avoids places that Paul had wanted her to go, finding strength in solitude and independence. But that feeling is shattered when he asks her to rescue their penniless, black friend, Mandla, an anti-apartheid activist who has been betrayed by a comrade who turned out to be a spy.

Andrea doesn’t like Mandla, his sanctimonious accusations, arrogance, and probing. He is a racist and a male chauvinist, given to violence. But his constant questioning finally unleashes deeper memories of the shocking abuses of her life in apartheid South Africa—memories she has suppressed or attempted to blame on class struggle rather than racial intolerance. She tries to provoke his empathy with the terrible tragedy of the long ago plague. He resists, being concerned far more with the present, but he relents a little and begins to see racism as a plague and walls as feeble, futile attempts to exclude others.

Andrea falls for Mandla, makes love with him near the plague wall, and decides to refuse Paul and return to South Africa. But Mandla rejects a future with her because he wants no vulnerability in his struggle. He is killed in the night by a car. Was the death deliberate? accidental? suicide? Andrea leaves anyway.

In a short second part, Paul writes to Andrea of his own growing doubts about their future together despite his love.

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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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A tightly walled cube-shaped block of buildings seemingly made of child’s building blocks looms in the midst of a barren foreground of stony rubble and a background of hazy nondescript sky. No sign of life, human or vegetation, anywhere. Entirely in shades of muted yellow, orange, ochre and brown, coloring suggestive of a crematorium, the canvas reeks of desolation.The only window into the tomb-like image, seen from above, is a carved cut-out star of David through which can be glimpsed a more detailed view of the abandoned ghetto. Barely visible, a pale yellow cloth remnant of the star of David stitched to their clothes to identify Jews sits atop one of the rooftop slates.

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