Summary:

Katie is a promising figure skater whose divorced mother drives her relentlessly to perfect her skills, at almost any expense. What her mother and coach don't know, but her English teacher begins to figure out, is that when Katie gets to an emotional edge, she hides and cuts herself; the pain and blood help focus her mind. Not until she goes over that edge one day at school and begins slamming her locker door on her hand and then banging her head on the wall does she begin to get the professional help she needs.

After a couple of false starts, she finds a psychiatrist experienced in working with teens in trouble who enables her to tell truths she hasn't for years been able to admit to herself or speak of to anyone else. Her mother resists other adults' help and almost succeeds in getting her out of therapy, especially group therapy with girls her mother labels "delinquents." But Katie finally manages to make some choices against her mother's wishes--an immense step out of the depths of years of co-dependence.

As the story ends, she has come to realize the girls in the group are capable of being real friends--something she hasn't had for a long while--and she is capable of making choices toward her own healing, the first of which is to seek and accept real help and to distinguish it from pleasing adults who are using her to assuage their own pain.

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This first-person narrative of a runaway girl's short stay in a residential mental health center develops her impressions, resistances, and accommodations from her admission ("I can see right away it's a nuthouse") to her release. These include reluctant interviews with the staff counselor, uncomfortable encounters with nurses, observations of other patients' erratic behavior, and efforts, finally, to communicate with a very detached roommate.

"Stevie" speaks from a place of anger and mistrust. She attempted suicide in the girl's bathroom by slicing her wrists, but regards herself as otherwise quite competent. A turning point comes for her when her silent roommate sings a song she's written which ends with the words, "Don't forget to cry." This moment of vulnerability, which also unveils surprising talent and beauty, moves Stevie from anger toward curiosity and sympathy.

She takes steps toward friendship with her roommate, and finally toward reconciliation with her mother who, she realizes, really wants her home. As she leaves, Zena really addresses her for the first time, reminding her, "Don't forget to cry."

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The narrator describes a housecall to a woman in labor. It is past midnight in winter time when the road is frozen. The doctor enters the house where the "great woman" is in misery; she is "sick," "perhaps vomiting," about to give birth to her tenth child. He exclaims to the reader "Joy! Joy!" knowing that the situation is as bleak as the wintry landscape, and, in fact, joyless. He will offer compassion and "pick the hair from her eyes."

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Warren here supposedly presents the papers of a late friend, detailing the interesting cases he had encountered as a physician. In fact, the "cases" are sensational short stories, presented as a novel due to the framing chapter introducing the narrator's "Early Struggles" to make a living as a physician. Other stories investigate typically Gothic themes like ghosts, duels, graverobbing, elopements, and broken hearts, with other scandalous problems like gambling, dissipation, murder, domestic abuse, and suicide. Medical topics include mental illness, epilepsy, hysterical paralysis ("catalepsy"), cancer, toothache, consumption, syphilis, heart disease, alcoholism, disease of the spine, gout, amaurosis (blindness), puerperal hemorrhage, measles, and stroke ("apoplexy").

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August is divided into two sections: "On the Corner of Fourth & Irving" and "To Marie Curie." The narrator, on a street corner in San Francisco near the teaching hospitals and medical school of University of California, San Francisco, meditates on the recurrence of lymphoma in a patient. Evening is approaching, fog blows in from the ocean, and the city pigeons are unsettled--landing and taking flight.

The meditation includes a tribute to Madame Curie and her discovery of the effects of radium. The patient had had a good chance of cure by radiation treatment--unfortunately, this patient is in the twenty percent who are not cured. The narrator, probably a physician-in-training due to the load of textbooks, had read the patient's chest x-ray as negative (normal) previously.

By the end of the poem, we learn that the physician had felt enlarged lymph nodes in this patient's neck today and he bluntly states: "I have failed. He has not been cured." The poem closes with the sound of the wind and the "beating and beating of wings."

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In the first section of the book ("Rejected Prayers"), Liveson proves that the prayers were not rejected; rather, they resulted in a group of thoughtful and moving poems. These poems speak eloquently of suffering patients, especially the elderly and neurologically compromised; for example, "Jenna," wearing her "diapered dress" (p. 16), "Sonnet to Sarah," who "lets her fingers trace the pattern on the wall," (p. 20), and the patient in "Praxis," whose "smile was rare but even" (p. 21).

These poems also speak passionately of social and historical pain, and of injustice writ large. Some of the most powerful are in the section called "Before the Plaster Sets," with which the book ends: "My First Death" (p. 63), "Holocaust Torah" (p. 66), and "Yom Kippur, 5760--Musaf" (p. 68).

The latter poem is a kind of contemporary re-envisioning of Allen Ginsburg’s 1956 poem "America." Jay Liveson writes, "Yom Kippur, this is serious. We sit here / hoping to somehow tune the engine / or at least check the map." Is tuning the engine enough? Perhaps we are fooling ourselves; much more needs to be done. How can we be content to sit and tune the engine in this unjust world? Perhaps the poem that speaks this theme most eloquently is "Statistical Causes of Traumatic Shock Syndrome in Gaza--Chart VII" (p. 72).

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Narrative competence is important for effective health care practice. By "narrative competence" I mean mastering a wide array of narrative skills, ranging from active listening and empathic responding in the client-practitioner interaction to reflective writing about one's professional experience. In the author's first book (The Therapeutic Potential of Creative Writing: Writing Myself, see this database), she explores the potential of creative writing as an aspect of therapy, and also presents some introductory writing skills. This book overlaps somewhat in covering the background for reflective practice, but focuses in considerably more detail on skill building.

Near the beginning of the book, Bolton presents a clear summary of "The Principles of Reflective Practice" (chapter 2). Recognizing that therapeutic writing is often accomplished in a group setting, the material on "Group Processes and Facilitation" (chapter 4), "The Creation of a Team" (chapter 5), and "Assessment, Evaluation, Mentoring and Values" (chapter 6) serves to introduce the last 100 pages of the book, which address specific writing skills, beginning with "How to Begin Writing" (chapter 8).

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A man walks through the countryside after a night of rain. The creatures around him are lively and refreshed. At first, he shares their joy, but his mood soon turns as he reflects that care and pain are the inevitable balance to the care-free life he has lead so far: "We poets in our youth begin in gladness; But thereof come in the end despondency and madness."

He comes upon an old man staring into a muddy pond. The man seems weighed down with care; he is so still he seems dead. He greets the man and asks what he is doing. The old man is a leech-gatherer, leeches being needed by eighteenth-century doctors. He wanders the moors, sleeping outside, and thus makes a steady living. The wanderer resolves not to give in to misery, but to think instead of the courage and firm mind of the leech gatherer.

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A doctor is called to the home of a poor, immigrant family. A beautiful little girl is quite ill. As diphtheria has been going around, the doctor attempts to examine her throat. The girl, however, won't open her mouth. She fights him off and all attempts to cajole her into compliance fail. Yet, the doctor is resolved to see that throat. He forces the girl's father to hold her down, while he manages to wrest open her mouth after a long battle. She does, in fact, have diphtheria.

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A sharp poem, directed to the sons of men. The poet wishes them periods, cramps, clots, and hot flashes. She wishes them the difficulties and embarrassments of the female gender. Mostly, she wishes that they experience the arrogance of gynecologists, "not unlike themselves."

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