Summary:

This book consists of a series of "found poems" abstracted from transcripts of interviews that Loreen Herwaldt conducted with 24 writers who had previously published accounts of their illnesses. Dr. Herwaldt, an infectious disease specialist at the University of Iowa, began her investigation into the personal experience of illness after having read Mary Swander's Out of this World: A Journey of Healing and Reynolds Price's A Whole New Life, both of which revealed a negative dimension of medical care. These books initiated an "unexpected turn" (p. 1) in Dr. Herwaldt's life, culminating in a sabbatical year during which she interviewed a wide array of writers, intending to investigate the texture and dynamics of their experience of medical care by textual analysis of interview transcripts.

However, as a result of a further (and fortunate) insight, the author decided to abstract and arrange these texts into "found poems" that have "a concentrated emotional power that the unedited stories did not." (p. 5) Among the authors whose stories of illness appear in these poems are Arthur Frank (see The Wounded Storyteller ), Nancy Mairs (A Troubled Guest: Life and Death Stories), Richard Selzer (Raising the Dead), Oliver Sacks (A Leg to Stand On), Mary Swandler (The Desert Pilgrim: En Route to Mysticism and Miracles), and Christina Middlebrook (Seeing the Crab: A Memoir of Dying). In most cases Dr. Herwaldt has crafted two or more poems giving voice to different aspects of the subject's experience. For example, Richard McCann (pp. 82-90) speaks about loving his primary care physician, why patients can't talk to doctors, what he needs from a doctor, and being labeled as a patient with hepatitis C (cf. "The Resurrectionist").

The author includes a section on "How to Use This Book" (pp.9-20) that summarizes her experience utilizing these poems in medical education settings and provides helpful hints for teaching them.

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This book chronicles a tortured parenthood during the birth and brief life of a severely brain-damaged female infant, Silvie. Doctors predict that the child will live only a few days but instead she survives for seven months. The story is told in first person by the mother, beginning with her arduous labor during a home delivery in the presence of an experienced midwife and the family physician. The baby does not cry when she is born and turns blue even with oxygen that the doctor administers. An ambulance is summoned; "a bigger, better oxygen machine" restores the baby's color and she is brought to a hospital neonatal intensive care unit where she is artificially ventilated and fed.

In the hospital Silvie "fails" all the tests of normalcy. The doctors recommend removing artificial ventilation. "I feared, even more than I feared her death I think (and harder to admit), that they would remove the oxygen pump and the baby would live on and on and never be able to do anything at all" (14). Yet when the child does in fact breathe independently, "I took the fact that she could sustain her own breathing to mean that the baby wanted to live. It was all right to love her" (15). A few days later, however, the medical team concludes that there is nothing further they can do for the baby, that the parents should take the child home, where she will likely die within a couple of days. Upon being prodded, one physician suggests the parents give her an overdose of phenobarbital, which she is receiving for continual epileptic seizures.

At home, the parents feed Silvie by tube, medicate her, change her diapers, hold her, and learn from a friend how to swaddle her. The child never cries, does not focus her eyes on anything, rarely responds to sound or touch, and gains no weight. Whatever random responsiveness there seems to be gives the author a sense of motherhood: "I was able to survive because of my faith in these intermittent chance meetings, believing that Silvie did know when I was here and that I was holding her close in a way that meant love" (37). The parents brace themselves for Silvie's death. The husband's sister visits and councils them to actively put an end to Silvie's life, which they refuse to do. But they do not plan to take extra measures (CPR) if Silvie seems to be dying at home and when they articulate this to a social worker whom they consult to obtain respite care, it becomes clear that she would report them to Child Protective Services.

The husband quits his job as a residential counselor of emotionally disturbed teenagers to do part-time carpentry work -- he is too preoccupied to care about other people's problems. When a friend accidentally breaks the phenobarbital bottle, the parents together with the family physician decide to see how Silvie will get along without the drug. To their amazement, the baby appears slightly more alert and is able to suck from a bottle -- no more feeding tube required. But the husband reminds his wife, "The doctors warned us she might do this. This is the one and only thing she can ever learn. They said when this happened to other parents they started to believe that the baby was getting better" (59).

The parents live in limbo, attempt to live a "normal" life. When Silvie starts to lose weight at age 4 months, the doctor advises to resume tube feeding; they don't see the point, but when hospital physicians use the word, "murder," and threaten to "take over" Silvie's care, the parents relent. The baby lives but "it was the sameness of Silvie that drove you crazy . . . She slept and woke, but was awake that much different? She did not change, she did not change. Her sameness was a stone I wore, an emblem of failure, failed life" (96).

The final act for Silvie begins when the author's mother-in-law is dying of cancer in New York and a decision is made to leave the baby at home in California for several days in the care of a retired nurse. The nurse has been shown how to do the tube feeding, but while the parents are in New York she experiments with spoon feeding, then discontinues tube feeding for three days before the parents return. The parents see that Silvie has deteriorated in their absence and resume tube feeding. For the remaining couple of months the parents wait, investigate institutionalizing Silvie, and finally determine that "the way we loved Silvie meant we loved her enough to let her die" at home, with "a certain amount of fluid and nourishment for comfort, but a gradual withdrawal of excessive food. Replaced with a lot of touching and holding, stroking and whispering" (122). Silvie dies and the author is four months pregnant with the baby she and her husband have decided not to abort.

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A brooding book that sounds the death knell for optimistic views on humanity's progress through civilization, Civilization and its Discontents begins with a recapitulation of Freud's disdainful views on religion as a psychological salve and then goes on to challenge enduring platitudes about human society: that civilization has emerged as a simple marker of progress of mankind over nature, protects us against suffering, and guards our liberties and happinesses. Comparing the development of civilization to the development of individual psychologies, he sees in both an essential conflict between eros and thanatos, between the desire to be with other people and the violence committed (or wished upon) other people.

Given that civilization is a process of negotiating and structuring communities, it must also be a way of controlling and repressing both violent and libidinous instincts; it does so not only through its laws but by infiltrating our own psychologies, which Freud discusses through the filter of his structural theory (where the instinctual, unconscious drives of the id are reined in by the ego under the fierce supervision of the inwardly aggressive superego). Freud's psychological perspective is to try to make sense of individual guilt, conscience, and remorse in the broadest social context as the products of this compromise between eros and thanatos, between the individual and the group, and between satisfying one's own instinctual drives and a broader community's needs. While some of his views are redolent of turn-of-the-century anthropology, his focus on guilt, aggression, and the murderous instincts towards extermination are very much prescient, charting the next decade and a half's fall into civilization's darkest hour.

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The book is split into three parts, the Analytic Part, the Synthetic Part and the Theoretical Part. The Analytic Part begins with an excellent synopsis of earlier theories of comedy, joking and wit, followed by a meticulous psychological taxonomy of jokes based on such features as wordplay, brevity, and double meanings, richly illustrated with examples. This section ends with Freud's famous distinction about the "tendencies" of a joke, in which he attempts to separate those jokes that have tendencies towards hidden meanings or with a specific hidden or partly hidden purpose, from the "abstract" or "non-tendentious" jokes, which are completely innocuous. He struggles to provide any examples of the latter. In the midst of his first example, he suddenly admits that he begins "to doubt whether I am right in claiming that this is an un-tendentious joke"(89) and his next example is a joke that he claims is non-tendentious, but which he elsewhere studies quite intensely for its tendencies. Freud uses this to springboard into an exploration of how a joke involves an arrangement of people - a joketeller, an audience/listener, and a butt, often involving two (the jokester and the listener) against one, who is often a scapegoat. He describes how jokes may be sexual, "stripping" that person, and then turns towards how jokes package hostility or cynicism.

The synthetic part is an attempt to bring together the structure of the joke and the pleasurable tendencies of the joke. Why is it that jokes are pleasurable? Freud's answer is that there is a pleasure to be obtained from the saving of psychic energy: dangerous feelings of hostility, aggression, cynicism or sexuality are expressed, bypassing the internal and external censors, and thus enjoyed. He considers other possible sources of pleasure, including recognition, remembering, appreciating topicality, relief from tension, and the pleasures of nonsense and of play. Then, in a move that would either baffle his critics or is ignored by them, Freud turns to jokes as a "social process", recognizing that jokes may say more about social life at a particular time than about particular people; he turns this into an investigation of why people joke together, expanding on his economical psychic perspectives with discussions of social cohesion and social aggression.

In the third part, Freud connects his theories of joking with his dream theories in order to explain some of the more baffling aspects of joking (including how jokes seem to come from nowhere; how we usually get the joke so very quickly, even when it expresses very complicated social phenomena; and why we get a particular type of pleasure from an act of communication). He ends with an examination of some of these themes in other varieties of the comic, such as physical comedy and caricature.

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The author's mission is to investigate, understand, explain, describe, and puzzle over the nature of phobias -- his own, and that of other sufferers. Allen Shawn is a composer, pianist, and teacher, and is a member of a gifted family: his brother, Wallace Shawn, is a playwright and actor; his father was William Shawn, for many years editor of the New Yorker Magazine. As a musician and academic, Allen Shawn is "successful." And yet, his life is severely limited by agoraphobia, "a restriction of activities brought about by a fear of having panic symptoms in situations in which one is far from help or escape is perceived to be difficult" (13). The author interweaves sections that summarize his extensive readings on the fight-flight reaction, evolution, brain and mind, Freud's theories on phobia--with his personal history, especially as he believes it relates to his phobia.

Shawn's descriptions of how he experiences agoraphobia are vivid and informative, detailing the situations that trigger his physiologic symptoms of panic and disconnectedness: driving on unfamiliar roads, any kind of travel that is unfamiliar, walking across or on the edge of open spaces, traveling across long bridges, being in enclosed spaces (claustrophobia). The agoraphobe, he writes, "feels at risk, as if at risk of sudden death or madness" (14). Shawn tells about what he must do in order to strike out on unfamiliar trips, that is, when he gathers up the courage to take them. He must venture up to the point where panic sets in, turn back, then on another occasion repeat the process but attempt to go further, pushing through the panic, until, one day, he can make the entire journey without turning back. Sometimes he never makes it to the desired goal.

The author points to several different factors that seem to predispose people to phobias: heredity, unconscious imitation of a phobic parent, upbringing. In his own case, in retrospect, his father showed symptoms of agoraphobia. Shawn discusses the underlying repression that was pervasive in his household -- his father carried on a long-term relationship with a woman while remaining married. Shawn's mother knew about the relationship from early on but any discussion of it was forbidden, even after it became common knowledge.

Perhaps more important in Allen Shawn's perception of repression is what happened to his twin sister, Mary, who was born with what is now considered to be autism, and mental retardation. Allen felt close to this girl, even though her behavior was unpredictable and baffling. When he was about eight years old, his parents sent her away to a special boarding school without warning Allen, or offering explanations. From then on he rarely saw her; 10 years later she was institutionalized. The family did not speak much about her and her "'exile' . . . added yet another layer of mystification to an already really mystifying atmosphere. It turned out that even in our temperate environment something extremely violent could occur" (177). Not long after that, Allen began to experience severe anxiety in certain situations.

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In his Introduction, editor Thom Schramm puts the themes of this anthology into perspective. He notes that the moods associated with bipolar disorder are familiar to everyone. Moreover, the notion that artistic creativity is associated with psychological instability is widespread; in fact, it is almost a stereotype, ranging in time from Plato's depiction of poets as suffering from "divine madness" to contemporary examples, like Sylvia Plath, Anne Sexton, and Robert Lowell. However, it should be evident that, since we all experience periods of sadness and elation, it is no wonder that poets of all stripes, no matter how "stable" they might be, may evince these moods in their work.

Living in Storms presents an array of contemporary poems grouped to reflect mania and depression from different perspectives. The book has eight sections. In the first three, the poet himself or herself expresses what it is like to be susceptible to mania or depression ("How It Is"), the experience of being there ("In the Mood"), and the experience in retrospect ("Remembering the Episodes"). The next two sections contain poems that approach these moods from more of a distance, either looking at the sufferer from another's perspective, ("Characters") or at the influence of manic-depressive sufferers on those around them ("Family and Friends"). The following section is devoted to poems about artists who suffered from manic-depression ("Artists"). The last two sections contain poems that depict shifts from one mood to the other, either on a daily or general basis ("Daily Shifts") or seasonally ("With the Seasons").

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Fifteen-year-old Webber hits a young girl, seriously injuring her, while taking a little illegal driving practice with his indulgent grandfather. Webber, himself, is injured, and unlikely to return to the track team he has loved. He has trouble remembering the accident during the first weeks of his recovery, especially since his grandfather has determined to take the blame for the accident. But as memory returns, aided by the bitter insinuations of a classmate who babysits the injured girl, Webber is torn between accepting his grandfather's cover for the sake of a clean record and an unencumbered high school career, and confessing. The technical fact that his grandfather was legally responsible for letting him drive complicates the ambiguity of his dilemma. Ultimately, he makes the decision to confess. The book concludes with his telling his grandfather of his intention--a decision that is sure to be relationally as well as legally consequential.

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This award-winning collection, published when the author was in her late 80s, contains 96 poems, most of them no more than one page in length. These poems are complex, interesting, surprising, and full of the pain of life. Stone has suffered and she does not hesitate to dwell on the causes of her suffering but she is not maudlin--she has lived and thought about life and she shows us how she lives and thinks.

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In the Arctic, winter goes on for ten months every year. The cold temperatures penetrate every aspect of human life. Existence is a struggle. In the Canadian community of Rankin Inlet, an Inuit woman finds personal tragedy as abundant as the snow. Victoria is diagnosed with tuberculosis (puvaluq) as a child and sent to a sanatorium far south of home. Following treatment with medication and a thoracoplasty, she returns to her town years later. Victoria's experience has changed her view of the world but she quickly discovers that in her absence, the people and locale have transformed too.

She marries an outsider, John Robertson, who is a British businessman. His success and local influence allow him to arrange for a foreign-owned diamond mine to open in the area, and with it, a new hospital for the territory. The couple have three children - a son, Pauloosie, along with two daughters, Justine and Marie.

Victoria seems a magnet for misfortune. At age 16, she has a miscarriage. A fourth child dies during a complicated delivery. Her marriage is increasingly strained beyond repair. Victoria's father suffers a stroke and becomes demented. Her mother dies of lung cancer. Husband John is murdered - someone slits his throat. Marie commits suicide. Pauloosie leaves home and sails to the South Pacific.

The Robertson family frequently interacts with the American primary care physician stationed in the isolated region. Dr. Keith Balthazar is a middle-aged atheist who has toiled in the Arctic for more than 20 years and abuses morphine. He keeps a journal of his experiences and meditations and commiserates with the local priest, Father Bernard.

Escape appears to be the best chance at happiness. For Victoria and most everyone else living in this harsh and beautiful land, survival - both physical and emotional - is hard. Personal choices are confusing. Nature doesn't seem to care one way or another.

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As the novel opens in 2002 we learn that the protagonist, Evan Patrick Molloy, has been wandering through a particular house and its yard for ten years, passing through its walls, unperceived by any of the people who have occupied the house. Evan is a ghost. The house he wanders through is the one he lived in when he deliberately put an end to his life by gunshot ten years earlier. It is the house he had lived in for a while with his ex-wife, Claudia after he resumed his relationship with her. Claudia's 10 year old daughter from a second failed marriage, Janey, lived with them. Several individuals and families have occupied the house since Evan's suicide. The current occupant is Maureen, who has moved there as part of her attempt to break off a relationship with her married lover, Ned, a radiologist.

Evan's story is revealed as flashback, interwoven with Evan's present-day fascination with Maureen and his watchfulness over her. The flashback chronology is not sequential but Maureen's life in the house and her interaction with Ned, who tracks her down, unfolds chronologically. As Evan thinks back on his life he tries to reconstruct the events, relationships, and state of mind that culminated in his suicide. At the same time, he wants to understand what is going through Maureen's mind and what motivates her actions. These two narratives merge at the end of the novel.

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