Summary:

Worlds Apart is a set of four documentary videos designed to stimulate thought and discussion about the effects of culture on communication and medical decision-making. Each video encapsulates the story of a real patient and his or her interactions with physicians and family.

The four videos are: (1) Kochi Story--an Afghan man, diagnosed with stomach cancer, decides about chemotherapy amidst miscommunication due to translation issues and religious convictions; (2) Chitsena Story--the mother of a four-year-old girl from Laos is caught between physicians who tell her that her daughter needs surgery to correct an atrial septal defect, and her mother who upholds the traditional Khmu beliefs that scars, including surgical scars, are injurious to a person in future lives; (3) Phillips Story--an African-American man on dialysis discusses the prejudices against black people in the health care system, particularly the decreased chances for receiving a renal transplant; (4) Mercado Story--a 60-year-old Puerto Rican woman who lives in Hell's Kitchen, New York City, explains the complex social situation which affects her ability to take care of her chronic health problems, such as diabetes and hypertension.

The films depict the patients and families in various settings--in doctors' offices, at other health care facilities, at home or work, during religious ceremonies. Phillips Story is different in that only the patient speaks during the film--in the other three stories we hear family members, translators, and physicians. The pitfalls of translation by a family member or friend are discussed, as well as the need for the physician to elicit information from patients about the social contexts that may affect their health and decisions.

For example, Mr. Kochi's religious beliefs contravene the use of continuous infusion chemotherapy, but not other regimens--this distinction is not elucidated for many months. Hence cultural competency in health care requires that the provider not assume reasons for patients' behaviors and decisions but rather emphasizes communication to understand the particulars of the situation.

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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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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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Set against the backdrop of the violent post-Duvalier years in Haiti, this novel traces the development of Sophie, the product of a violent rape. Having been raised lovingly by her aunt in a village near Port-au-Prince for 12 years, Sophie is suddenly sent for by her mother (who had immigrated to the United States as an asylum seeker). Living in New York, Sophie discovers that her mother is haunted by violent nightmares, a remnant of the trauma she had suffered before fleeing Haiti.

Part Two opens as Sophie, now 18, falls in love with her neighbor, a musician named Joseph. Her mother, upon finding out about Sophie's love interest, begins the humiliating tradition of her mother, "testing" Sophie's virginity by inserting a finger in her vagina to make sure the hymen was not broken. After several "tests," Sophie painfully breaks her own hymen with a pestle and immediately runs off with Joseph.

Part Three of the novel opens about a year later, when Sophie has left her husband and returns to Haiti with her baby daughter. Here, she begins learning about her mother's past as well as telling her aunt and grandmother about her own current sexual dysfunction and her bulimia. Sophie and her mother reunite and reconcile in Haiti and later return to the States where Sophie returns to Joseph and begins a kind of therapy that includes rituals from Haitian, African, and Chicana traditions.

Meanwhile, Sophie's mother becomes pregnant (by her long time lover and friend) and increasingly agitated, finally committing suicide. At the funeral, in Haiti, Sophie runs into the cane field where her mother had been raped some 20 years earlier. As she is screaming her grief and rage, she tears at the cane stalks. Rather than attempting to stop her, Sophie's aunt and grandmother watch her, finally asking, "are you free?" and then insisting, "You are free!" (p. 233)

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Not quite the familiar home-for-the-holidays genre of a dysfunctional family, this one has a twist.   April is a late-teen "problem" daughter who has run away to New York City where she lives with her boyfriend, Bobby (Derek Luke).  April, played by a grungy, pigtailed, and probably tattooed Katie Holmes, has invited her parents, siblings, and grandmother to Thanksgiving dinner.  This reunion, we gather, is the first since April left home.  The family is coming to her lower East Side tenement, a situation that bristles with possibilities.  

Moving back and forth from April's low rent apartment to tension in the crowded car as it moves from a scenic suburb to cityscape, viewers are able to watch both April's unskilled efforts as she struggles with the slippery turkey, a can of cranberry sauce, crepe paper decorations, a broken oven, etc. and an inexplicable drama slowly unfolding in the crowded car.  In spite of crisis situations in both settings, the separate family members do get together for a dinner that neither could have planned. 

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At fourteen, after marginally consensual sex with a boyfriend, Jane has a baby.  She managed to keep her pregnancy a well-camouflaged secret until late in the process; both family and friends are still reeling from her late-breaking news.  Her mother has died; her grandmother has moved from the tribal reservation to live with Jane, her father (a white Canadian), and Jane's two brothers.  Though the school she attends has daycare for students' babies, Jane finds little emotional support, even among former friends, until a new girl, Dawna, takes an active, unpretentious interest in both Jane and the baby.

With Dawna's and her grandmother's help Jane decides to make the rather complicated arrangements required to allow her to audition for the school play and pursue a longstanding dream of singing and dancing on stage.  She meets with fierce and aggressive competition from a much more privileged girl who does her best to discredit Jane's efforts on account of her unfitness as both a Native American who doesn't look the part, and as an unwed mother who, as one faculty member puts it, shouldn't "parade herself" in public.  Nevertheless, Jane's skill and determination and soul-searching pay off; despite the steep learning curve required to care for a baby and the psychological cost of teen motherhood, she succeeds in making the accommodations and compromises necessary to retrieve old dreams on new terms.

            

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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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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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The overworked doctor-narrator finds himself extremely irritated by the requests of a poor immigrant couple in their twenties to examine their infant. He spouts an alarming number of cultural and economic prejudices and tries to avoid seeing them. They persist, however, and the doctor examines the child, whom he finds healthy. The husband then asks if the doctor can examine his wife. The doctor flashes his anger again but agrees.

He finds her legs extremely bowed, probably from severe childhood rickets, and asks the husband about her history. It turns out that she had grown up in Poland during World War I and had lost all her family. As he hears of the woman's suffering, the doctor becomes empathetic, suddenly understanding the couples' fearful tenacity which had so annoyed him before. The woman responds in kind, and the doctor-patient relationship changes significantly for the better.

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Twenty-one stanzas of couplets spin out stereotypes of Native Americans promulgated by white American culture.  Among those stereotypes that Alexie develops: the tragic Indian; Indian women as sexual objects for white men; Indian men as secretly desirable to white women; Indians as violent, alcoholic, childlike, mystical, and members of a "horse culture."  But in addition, Alexie emphasizes how American whites have co-opted Indian culture: "white people must carry an Indian deep inside themselves" until finally, "all of the white people will be Indians and all of the Indians will be ghosts."

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