Summary:

In this tightly organized study of the relationship between creativity and manic-depressive disease and its variants, the author asks and attempts to address some interesting questions. Is there sufficient evidence in the histories of well-known artists and their families to demonstrate a genetic linking of creativity and depressive disorders? Are there phases in classic bipolar cycles that are particularly conducive to bursts of, or sustained, creative productivity? Does treatment (be it chemical or psychotherapeutic) of his or her psychiatric symptoms blunt the ability of the artist to work successfully?

In an attempt to answer these and other intriguing questions, Jamison explores in some detail the personal, family and creative histories of writers long suspected of being depressed with or without alcohol or having periods of mania. She opens by defining for the novice the parameters of the disorders in question, examines some of her subjects' family history of "madness," and discusses evidence for relationships among the waxing and waning of depressive disorders and creative productivity.

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The story is told of Byelikov, "the man in a case." Byelikov, the Greek teacher at a provincial school, was extraordinarily orderly both in his personal and professional lives. A strict disciplinarian, he never made exceptions to the rules. He always did things the proper way, determined to avoid even the appearance of impropriety.

Although he and his colleagues had nothing to speak about, he would regularly visit each one of them because it was the accepted thing to do. Every time something slightly irregular came up, Byelikov would cry, "Oh, how I hope it doesn't reach the ears of the authorities!" Naturally, the other teachers hated him.

At one point, Byelikov became enamored of Varinka, the sister of Kovalenko, a new teacher at the school. Everyone encouraged this relationship, hoping that marriage would moderate Byelikov. However, someone drew a humorous caricature of Byelikov and Varinka.

Then, Byelikov saw Varinka and her brother bicycling in the park. Outraged, Byelikov went to the brother to complain about this scandalous behavior, but Kovalenko pushed him down the steps. Byelikov than became depressed, took to his bed, and died, thereby truly becoming a man in a box (i.e. a coffin).

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An army lieutenant named Klimov is returning home to his sister and aunt in Moscow and falls ill while on the train. His mouth is dry, his brain turns to mush, and he keeps hearing a strange voice cry, "Is the mail ready?" When he finally arrives at the station, he collapses. During the next days or weeks, he thrashes around his bed in delirium, latching onto disconnected images of a cheerful doctor, a grave priest, and various acquaintances and events.

One morning Klimov awakens feeling well. His whole being is filled with a sensation of happiness. He learns from the doctor that he has survived a case of spotted typhus. But where is his sister Katya? His aunt groans, "Ah, Katya, Katya! Our angel is gone! Is gone!" Indeed, Katya had caught typhus from her brother and died. Her funeral had taken place the day before. Pavel's "heart ached, he burst into tears, and leaned his forehead against the window frame."

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Penny (Michele Hicks), working as a prostitute, is called to a room in a seedy hotel where she finds her client is a pair of adult conjoined twins, Blake and Francis Falls (played by identical but not conjoined twins, Mark and Michael Polish, who also co-wrote the screenplay). Shocked, she flees but later returns and, when she learns that one of the twins is ill, calls a doctor friend of hers to examine them. She cares for the twins and they become friends. At Halloween, "the only night of the year they [can pass for] normal," she takes them to a party and then back to her apartment where she and Blake almost make love while Francis, evidently the weaker twin, is sleeping.

She tells her lawyer/pimp about the twins, and he tries to persuade them to sell him their story (which he imagines in terms of separation: "The greatest divorce of all time: not who gets the kid but who gets the kidney . . . "). Offended by her betrayal, they return to their hotel room, and, apparently for the first time, the twins fight. Blake wants to get away from his brother.

The next morning Francis is ill once more, and the twins are hospitalized. Michele visits them and learns that they are dying. Francis's heart is becoming weaker, straining Blake's, and the only way to save Blake will be by separating them. Francis cannot survive separation. Penny tracks down their mother (Lesley Ann Warren), who gave them up for adoption at birth. She visits them in hospital. It emerges that Penny herself has a "retarded" child who is being raised by others. Francis's heart fails, and the twins are taken to the operating room.

Later, Penny tracks Blake down where he is now living alone in the trailer where the twins had lived before, as circus performers. The film ends with Blake, now a man with one arm and one functioning leg, telling Penny that the "story of me is over," but also that stories continue after sad endings. What makes an ending sad, he tells her, is the knowledge that the storyteller is continuing without you.

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Told from the perspective of a thirteen-year-old girl, this story about a single mother with two daughters who moves, marries, and dies of breast cancer handles a variety of difficult issues with sensitivity and spunk. A list of those issues--absent father, new stepfather, a thousand-mile move to a new social environment, first menstruation, sibling rivalry, an uncle with incestuous impulses, family secrets, sexual experimentation, cancer, and death--might make it sound like a catalogue of the trials of contemporary suburban young adulthood, but in fact the point of view of Tilden, the main character, keeps the story grounded in very believable, sometimes amusing, often poignant, recognizable truth about what it is to come into awareness of the hard terms of adult life.

The mother's cancer is narrated largely in terms of Tilden's experience of it: secrecy, eventual disclosure, partial information, losses of intimacy, feelings of betrayal, confusion about caregivers' roles, and in the midst of it all, the ordinary preoccupations of early adolescence. The generous and understanding stepfather and neighbors with limited but ready sympathies lighten some of the novel's darker themes.

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This historical novel for young adults details the horrors of the Philadelphia Yellow Fever epidemic in 1793 from the point of view of a fourteen-year-old, Mattie, who runs a coffeehouse with her widowed mother and grandfather. In the course of the story, her mother is taken ill, she herself falls ill on the way to the safety of the countryside, and her grandfather dies of heart failure after nursing her. Separated from her mother who is also removed from the city, Mattie finds herself scrabbling for survival in a mostly deserted town after the death of her grandfather, but relocates the free black woman, Eliza, who had worked for her family and who essentially becomes part of her family.

Eventually the mother returns, an invalid but alive, and Eliza and Mattie undertake to run the reopened coffeehouse together and care for Eliza's nephews and an orphaned child Mattie has rescued. Hope reappears with the first frost in the forms of a reopened farmers' market, the return of George Washington to the town, and the reappearance from enforced isolation of Nathaniel Benson, a young painter who gives Mattie a vision of a future life with friendship and love.

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The poem tells the story of one who travels to the hot springs seeking a cure for his chronic illness/disability. For 25 years the subject faithfully visits what remains of the opulent dream of spa-builders--a bubble that burst for both the entrepreneurs and their visitants. In the nearly deserted town, the poet's character continues to seek relief without success, yet he remains. The writer seems to be asking if it has become the search itself that keeps the sufferer alive; if he were to suddenly be made well perhaps he would lose everything in losing his familiar identity.

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This gripping narrative traces the history of the efforts to eradicate smallpox in the 1970s, the top-level decisions to keep a few vials of it for emergency purposes in American and Soviet freezers, and the reemergence of smallpox not only as a health threat, but as a potential bioweapon of unequaled destructive power. Preston details maverick natural cases that surfaced after worldwide eradication efforts, how it was discovered that undocumented reserves of smallpox were not only being kept, but researched and possibly "weaponized," and how hotly, in the US, teams of scientists and military intelligence personnel debated funding new smallpox research in the US with a view to developing a new vaccine as a defense.

The ethical issues in those debates are unprecedented in the scope of the possible public health threat and the variables that might make traditional vaccination ineffective against the weaponized virus. As in his previous books on biological threats, The Hot Zone and The Cobra Event (see annotation), Preston follows the work and lives of several key scientists and includes scenes from interviews with a variety of persons involved in confronting the political, ethical, and medical dilemmas posed by smallpox research and efforts to track and control it.

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When literature and cultural studies professor Michael Bérubé's son James was born in 1991, he was diagnosed with Down Syndrome. Negotiating various medical, social, and educational environments and the identities each assigns their son, Bérubé and Janet Lyon (his wife, a literature professor and former cardiac-ICU nurse), become effective advocates for Jamie and embark on a course of questions about the social systems that produce disabled identities and administer to those human differences termed significant ones. Bérubé engages these questions with a mixture of family experience (his own, and that of other families with disabilities), historical research, critical theory, and sophisticated critical analysis.

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This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.

The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.

Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."

This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.

Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.

Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).

These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.

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