Summary:

Having previously described his seven years as a family practitioner in rural Minnesota (Healing the Wounds, Pantheon Books, New York, 1985) Hilfiker now has turned his attention to a decade in inner-city Washington, D.C., where he practiced what he calls "poverty medicine." These introspective essays are written in a style similar to that of his first book and detail the profound struggles of the overwhelmingly African-American community he serves and lives with.

Also examined are his and his family's battle to live with their white middle-class privileges in the midst of this impoverished community. This book very effectively alternates between the numerous stories of his personal encounters with patients and deeply reflective commentary about those encounters. Prescriptions are not offered other than that a new art of caring for the poor is needed.

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Writer Paul Monette's first-person account of living through his lover Roger's last nineteen months with AIDS, from diagnosis to death (1986), told in language that is poetic and highly articulate. The couple faces not only progressive physical degeneration (Monette calls time with AIDS a "minefield") but also the agonizing issues of truthtelling with their families, friends gay and straight, and the world, in "the double closet of the war."

Fact-finding is a constant obsession in this story, not only about who is positive and who knows, but also in the rapidly-changing medical arena, where through Monette's extraordinary efforts Roger becomes the first person west of the Mississippi to be put on the drug, AZT. Monette is so devoted a caregiver that he often loses himself--a problem he solves in part by turning to the subject of AIDS as a writer.

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Will Hunting (Matt Damon) comes from Southie, a rough district of Boston, and works at night as a janitor at the prestigious Massachusetts Institute of Technology (MIT). Will writes on some math class blackboards when no one’s looking, and Professor Lambeau (Stellan Skarsgard) discovers that Will is a natural mathematical genius. Lambeau tries to bring Will out of his go-nowhere environment into the academic world where his talent will be appreciated.

Will half-agrees, but he still hangs out with his tough crowd in Southie (including Ben Affleck as Chuckie), and he winds up getting arrested after a fight. Lambeau keeps Will out of jail through an arrangement that includes his mentoring plus Will’s going for psychotherapy with Sean McGuire (Robin Williams). That course of psychotherapy is the core of the film.

Sean’s treatment of Will in therapy involves lots of risks, but through a combination of empathy, rule-giving, self-revelation, and provocation, Sean manages to bring Will to understand that the severe physical abuse he suffered as a child at the hands of his foster parents is not his fault, and that he really is a good person who has a lot to offer. (This can sound corny unless you are the one who is making the discovery.)

Sean gains some credibility with Will when he admits that he, too, had suffered abuse as a child. Will’s realization makes possible a much more positive self-image and a whole new vision of life. He decides to stop denying his talents and to recognize that he might be good enough after all for brilliant and charming (and independently wealthy) MIT student Skylar (Minnie Driver), who loves him, and whom he finally leaves Southie to follow as she heads west for graduate school.

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Set in 19th-century Japan, the film’s action centers on the experience of the young doctor Yasumoto (Yuzo Kayama) in his work as an intern at a hospital-clinic for the poor run by the experienced and wise Dr. Kyojo Niide (Toshiro Mifune), nicknamed "Red Beard." Coming from a wealthy and influential family, and fresh from a Western-influenced medical education at Nagasaki, Yasumoto had believed he was on the path to become physician to the shogun (equivalent to a king).

He is initially insulted and deeply unhappy with conditions at the distinctly inglorious clinic. The poverty and suffering (and smell) of the clinic’s patients disgust him, and he tries his hardest to get fired. The mysterious Red Beard, however, is extremely patient, and simply waits. While he waits, we see Dr. Yasumoto slowly being converted as he is brought into close contact with the suffering in the lives of several patients.

Initially rebellious and emotionally unable to watch patients die or assist in surgery, Yasumoto gradually becomes a seasoned and enthusiastic member of the clinic’s medical team and announces that Red Beard is his idol. At the end, when Yasumoto is actually offered the position of physician to the shogun, he refuses, in order to continue his work at the clinic.

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Simi Linton, a major voice in disability rights activism, has written the story of her journey from car accident "victim" to college professor, disability studies scholar, and political activist. Her memoir of personal experience is interwoven with the evolution of her thinking about disability as social construct and the development of the disability studies movement and political engagement.

In 1971, Linton was a young married hippie--a college dropout hitchhiking her way to a protest march against the Vietnam War, together with her husband and best friend. Suddenly there was a car crash: her husband and best friend were killed and Simi sustained a spinal cord injury that left her legs paralyzed. There followed a year of hospitalization, surgeries, and in-house rehabilitation.

Although forced to be a recipient of attention and care, Linton even then was not inclined to play a passive role. "Even in this forest of overseers, where every move I made was scheduled . . . I had opinions. . . . Doctors . . . had saved me, and saved all my new friends, but I was outraged when they spoke for me or spoke down to a nurse I liked" (15). While still institutionalized, Linton took on the cause of petitioning the medical staff to educate patients like her about leading a sexual life as a disabled person. She determined to return to college as a psychology major so that she could eventually implement sexuality programs in rehab centers.

Linton details the activities of daily life that she had to adjust to and the strategies she adapted to maneuver, with her wheelchair, in her home, to go shopping, to travel, to attend classes. Family and friends and some social services were helpful but everywhere, life was designed for the abled body. This was a "fact of life"--"I had a feeling it could be different, but didn't know where to begin. I was having enough trouble just getting around" (28). She kept from thinking too much about her situation and her losses by staying busy and trying to be as independent as possible, but eventually needed the support of a therapist "who could bear my weight" (37).

It was in 1975 that Linton's disability rights "consciousness" was first stirred. On her own, she left her New York apartment to live in Berkeley, California for awhile. There she discovered "The Center for Independent Living" where the employees and volunteers were themselves disabled and whose goal was to assist disabled individuals to find ways of living independently. "I had been so tentative about my disability, and had, up to now, only ascribed a very personal meaning to it--this is what happened to me, this is the effect on me--that their forthright ownership of disability and their drive to take action based on the collective experience set my mind racing" (53).

Another defining moment came when Linton took a course on the psychology of women at Barnard College. "We examined the myths inherent in the so-called objective knowledge base" (64). Simi drew a parallel between knowledge generated from the male perspective and knowledge presented from the perspective of the abled body. "Unlike the [classroom] readings . . . which challenged traditional conceptualizations of women's roles and framed issues from an insider's perspective, the rehab literature recounted clinicians' views about disabled women's needs and experiences that seemed far removed from the way that I and the disabled women I had been meeting actually felt. It looked at us, and, it felt, through us, and I mistrusted all of it" (64).

The memoir continues with Linton's decision to work outside the realm of institutional medicine, her co-organizing the National Coalition of Sexuality in Disability, her falling in love with and marrying the man who is her (second) husband, her growing awareness of the silence surrounding disability and questions of access, and her dedication to change individual and society's discriminatory practices and to bring awareness of what we now call "the social construction of disability."

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Written in a style resembling religious litany, this is the tale of a disastrous teen-age marriage and its criminal consequences. The setting is California. Maria is a poor Mexican-American who meets and attracts Russell, a working class Anglo. Although ambivalent, Maria sees marriage to Russell as the path to American, white respectability. Her earlier hopes of achieving this status through her own efforts have been frustrated by the reality of poor academic performance. She is eager to get away from the household of her deeply religious mother. Russell is brooding, taciturn, and carries the physical and psychic wounds of an abused childhood--his father is a partially reformed alcoholic who deliberately burned Russell's hand.

The pair are ill-equipped for marriage or parenthood and Maria soon feels trapped. Their son, John, avoids provoking them by being a "good boy," hoping to prevent their frequent arguments. Russell's deprived childhood accounts, perhaps, for his obsessively jealous fixation on Maria. He is jealous even of the attention she gives their son.

The catastrophe that seems always close at hand finally occurs: Russell sets fire to his own child. The second part of the novel is told primarily from John's perspective as he undergoes a prolonged, painful rehabilitation and tries to find meaning in these events. It is also the story of the plastic surgeon who attempts to restore John's horribly scarred body and who has come to doubt the purpose of his profession (there is nothing he can do about destructive family relationships and psychic scars). Russell, who has been brutalized in jail, is released, seeking redemption. Fire, significant throughout the story, plays a final shocking (redemptive?) role.

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This is the second edition of Hawkins's groundbreaking work on illness narratives--autobiographical and biographical accounts of illness that she calls "pathographies." This edition preserves the text of the earlier (1993) work but updates it with a new preface and a new concluding chapter. This new chapter (chapter 6) surveys works written since 1992 and expands the discussion of mythic thinking and narrative.

Hawkins posits that mythic thinking pervades illness writing. Mythic constructs, she argues, organize the way patients understand their illness, how they interact with the institution of medicine, and how they write their narratives. Myths are formulative in that they attempt to create order out of the disorientation of illness. In the texts selected, Hawkins identifies "archetypal" (transcultural, transhistorical) myths--myths of journey, battle, and death and rebirth (discussed in the first edition as well).

In this edition Hawkins introduces a new term: "ideological" myths. Ideological myths are "linked to a particular culture at a particular time" (xiii). In this category is the myth of healthy mindedness, a way of thinking that was labeled "mythos" in the earlier edition. Hawkins proposes two additional ideological myths, discussed in chapter 6: the Gaia myth (that links illness and environmental problems), and the "myth of narrativity" (xiii).

The book's chapters are organized around the myths enumerated above, with many examples. Most of the works discussed were written in the latter part of the 20th century, but there are several pages devoted to John Donne's Devotions upon Emergent Occasions (see annotation in this database). Hawkins determines how, in specific cases, the myths she has identified function--whether they are "enabling" or "disabling," and whether they are "medically syntonic or dystonic" (21-24). Myths that have an enabling function are adaptive, useful, help recovery or adjustment, ameliorate suffering. They are often medically syntonic--compatible with the belief system of Western medicine. One notable exception to this is Hawkins's paradigm of the ideological "myth of healthy mindedness," in which to be enabled often means to controvert traditional medical practices.

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Peter Selwyn spent the first ten years out of medical school at Montefiore Medical Center in the Bronx, caring for HIV-positive patients--mostly intravenous drug users and their families--in the early years of the AIDS crisis. As he worked with dying young men and women and their families, Selwyn returned to his own unexplored pain surrounding the loss of his father, who fell or (more likely) jumped from a 23-story building when Selwyn was a toddler. Mirroring their function in Selwyn’s life, the stories of the five patients who most affected him serve in this book as the threshold to the narrative of how Selwyn investigated, mourned, and commemorated his father’s death, finally revaluing it as central to the person and doctor he became.

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Lenny's development from childhood to adolescence concurs with India's independence from Britain and the partitioning of India into India and Pakistan. The interwoven plots give each other substantial meaning. Partly because Lenny's family are Parsees, a religious and ethnic minority that remained relatively neutral in post-Partition religious conflicts, she has access to people of all ethnicities and religions, both within Lahore and in other locales. More significantly, she has access to a wide variety of viewpoints both pre-and post-Partition through her Ayah, a beautiful woman whose suitors are ethnically and religiously diverse.

Lenny's passionate love of Ayah and the loss of innocence that accompanies their changing relationship through the Partition is an energetic center to the plot. Lenny's relationships with her mother, her powerful godmother, and her sexually invasive cousin are also important to the novel. Lenny's polio forms a significant early narrative thread. Other minor but compelling subplots include Lenny's parents' changing relationship, the murder of a British official, and the child marriage of the much-abused daughter of one of Lenny's family's servants.

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A night on the town with two friends turns into "an attack of nerves" for Vasilyev, a law student. The three students spend the night drinking and visiting houses of prostitution; Vasilyev is horrified and repulsed by the women, who he thinks are "more like animals than human beings." The social problem of prostitution becomes an obsession; he is so fixated on finding a solution that he is in moral agony. His friends, among whom is a medical student, are concerned only with his health; they take him to a psychiatrist who "cures" Vasilyev with bromide and morphine.

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