Summary:

The author, a pediatrician by training who has gradually moved into psycho-oncology and training others in relationship centered care, writes about life in this collection of short vignettes and analyses. She blends stories of her own experiences as patient and as woman with those she has gathered from a long history of patient encounters. There is no temporal sequence, but the work is grouped into thematic segments. The author shares selected, carefully garnered and assessed narratives of life events intended to be spiritually healing to those who are ill or who care for the sick.

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This is a collection of twenty-six first-hand accounts by women institutionalized in mental hospitals or "asylums" in America between the mid-nineteenth century and the end of World War II. The book is divided into four historical periods, each introduced by the editors with an essay contextualizing the narratives in relation to the history of the psychiatric establishment, and to the roles, perceptions, and experiences of women in American culture.

The accounts are all extracts from works published by the writers, usually as attempts to expose the injustices of the mental health system. Most of the writers are not well known, with the exceptions of the author Charlotte Perkins Gilman and the actress Frances Farmer, whose account concludes the book [see film annotation in this data base: Frances].

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Determined not to like Ruth Thomas, Ann Stanley is immediately smitten by her charm and force of personality, and especially by her vitality--a vitality that too soon succumbs to breast cancer. As one of a cadre of women almost obsessively devoted to the care of a dying Ruth, Ann nurses Ruth through her final illness, until--in a move curiously like the decision of Charity (also dying of cancer) to keep Sid, her husband, sequestered from her final trip to the hospital, in Wallace Stegner's far superior novel, Crossing to Safety--Ruth flies to Florida to die at her brother's house.

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Showalter identifies clusters of syndromes, or mini-epidemics, which she suggests represent late-twentieth century manifestations of the entity which was called hysteria in nineteenth century western culture. Opening with the history of psychiatry's involvement in hysteria in the time of Charcot and Freud, she traces the replacement of hysteria or conversion reaction by modern hysterical analogues such as: chronic fatigue syndrome, recovered memory, Gulf War syndrome, multiple personality syndrome, satanic ritual abuse, and alien abduction.

In separate chapters she examines each of these entities--how it presents, how it fits into her theory of mass hysteria as a cultural response to the millennium, and how it is being handled by health care professionals. Showalter contends that "Redefining hysteria as a universal human response to emotional conflict is a better course than evading, denying, or projecting its realities." (p. 17)

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Narrated in the style of an "advice" manual, this is the chronicle of a woman who undergoes a hysterectomy and removal of her ovaries. The tone is sardonic. The story begins with the office visit in which the doctor delivers the news and reassures her that she is too "intelligent and sophisticated" to associate her womanhood with her reproductive organs. The physician attempts to persuade the narrator to have her ovaries removed--preventive medicine against the possibility of ovarian cancer--and she finally agrees while groggy from pre-operative anaesthesia. Nothing has prepared her for the emotional and physical lability she experiences after surgery. Even her sexual relationship with her husband is changed.

As she returns for post-operative check-ups, she becomes increasingly conscious of the indignities of the office visit and physical examination: "it strikes [her] that this maximum-efficiency set-up [three cubicles with naked, waiting women] might serve equally well for a brothel and perhaps already does." She feels that she has made a terrible mistake in allowing the doctor to have talked her into anything and that as a male, "there is nothing he can tell you about how you feel, for the simple reason that he does not know."

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Seventeen year-old Phyllis Halliday lives with her parents near the maximum security penitentiary in Kingston, Canada. In the year 1919-20, she establishes a forbidden, epistolic relationship with convict Joseph Cleroux, who is serving a sentence for theft and extortion. Messages, money, and small gifts of tobacco, chocolate, and a ring, are concealed in the quarry next to her home where the convicts are sent to work. Influenced by the newly released film with Mary Pickford, she dubs her new friend "Daddy Long Legs," and herself, "Peggy."

Both Phyllis and Joe fear being caught, and they suffer from parallel illnesses. As she falls in love with the man whom she has never met, she neglects her studies, hoping that he will come for her when he is discharged. However, on that day, he is immediately put on the first train out of town. His letters dwindle and cease, but Phyllis continues to wait and hope.

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The setting is Germany in the late 1920s. Rosalie, the central character, is a "sociable," cheerful 50 year old widow who lives with her adult unmarried daughter and her adolescent son. Her manner is youthful but "her health had been affected by certain critical organic phenomena of her time of life." Rosalie is keenly aware of all that menopause implies: the loss of sexual allure and of a (biologic) purpose in life. She feels "superannuated."

Along comes a young man, well-built, who is the American-born tutor for her son. She is overwhelmed by physical attraction for him, becoming infatuated, much to the disapproval of her repressed, cerebral daughter. She feels young and attractive once more, believing that her heightened state of sensuality has resulted in the resumption of what appears to be menstrual bleeding.

Planning to declare her love to the tutor, Rosalie arranges a family excursion to the Rhine castle where the black swans swim. In the decaying alcoves of the castle, she does so; the pair will rendezvous that night. The rendezvous never takes place; Rosalie has hemorrhaged. She is found to have a large, metastatic uterine tumor.

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For forty years, James Langstaff (1825-1889) practiced medicine in a small town near Toronto. He witnessed the advent of anesthesia, antisepsis, new drug remedies, germ theory, and public health. Chapters are devoted to his management of surgery, obstetrics, and diseases, especially in women and children, his finances, and his role and that of his suffragist wife in the political and social fabric of their community. A reformer and temperance advocate, Langstaff was quick to adopt medical innovations, but slow to abandon familiar practices.

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Dr. Cassell examines the social and cultural forces that encourage the practice and teaching of a medicine that is governed by the disease theory. This theory discounts the impact of illness on the patient and ignores the suffering that the patient is experiencing. Cassell does not debunk science and technology, rather he encompasses them within the moral enterprise of medicine as tools for helping patients.

The ability to provide compassionate attention to the patient as individual (i.e., with unique values, life experiences, family interactions, etc.), trustworthiness and self-discipline are required characteristics of a "good physician." Cassell illustrates and personalizes the philosophical shift towards focusing on the sick person with stories and anecdotes.

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This autobiographical account of Dr. Lown's five decades of practice and research in cardiovascular medicine is both a history of the field and a history of a man passionately interested in people and healing. The book is divided into six sections: Hearing the Patient: The Art of Diagnosis; Healing the Patient: The Art of Doctoring; Healing the Patient: Science; Incurable Problems; The Rewards of Doctoring; and The Art of Being a Patient.

The first three sections comprise the bulk of the book: Lown chronicles his early medical training and career through stories of memorable patients, anecdotes about key role models (particularly Dr. Samuel A. Levine), and histories of medical mistakes, diagnostic acumen, and his remarkable research innovations. These achievements include the introduction of intravenous lidocaine, cardioversion and defibrillation, and development of the coronary care unit.

The core of the book, however, is about how deeply Lown cares for his patients. He states, “This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.” The book contains many reflections on medical practice, such as this definition of medical wisdom: “It is the capacity to comprehend a clinical problem at its mooring, not in an organ, but in a human being.”

In a thoughtful chapter on death and dying, Lown muses on his emotional and spiritual responses to encounters with death, and bemoans the medical profession's increasing tendency to “put technology between us and our patients, to spare us the grief of failing to confront our own mortality.” In the final chapter, Lown takes an unusual twist, and writes a treatise to patients on how to get the doctor to truly pay attention to them and what are reasonable expectations to have of one's doctor.

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