Summary:

In September 1796, 32-year-old Mary Lamb (1764-1847), stabbed her mother to death with a carving knife during an incoherent frenzy. Almost immediately, she became calm and was sent to a madhouse, remaining away from home for months until her grieving and unforgiving father had died. Mary was released into the care of her much younger brother, Charles (1775-1834), soon to be known for his poetry and essays. She never went to prison, but would return to the madhouse many times over the next fifty years. As a result, this life is an interesting exploration of chronic mental disturbance in the early nineteenth century.

Neither Charles nor Mary ever married; they always lived together and professed to be each other's dearest friend. Obliged to eke out a middle class income--she (until her crime) at dressmaking, he in an office--they turned to writing, often together. The Lambs' famous Tales from Shakespear [sic] was written mostly by Mary, but their friend William Godwin under Charles's name as sole author first published it. Mary's other books, edifying texts for young female readers, were published anonymously.

Letters to their many friends reveal Mary's vexation with Charles's drinking and smoking and his concerns over her multiple relapses, which were triggered by being obliged to move house. Charles predeceased his older sister by ten years and she spent the rest of her life in chronic care of a private couple, visiting his grave almost every day.

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This is a series of vignettes involving a small cluster of patients in an early twentieth century tuberculosis sanatorium located in Scotland. The stories are narrated by one of the patients who makes observations and predictions about his peers in the institution. The lives Maugham chooses to have narrated are those of two men, long-term residents, whose daily entertainment is to irritate one another. There is a mixture of humor and pathos in the dialogue between these two. The second story within a story is that of the developing love between a dying man and a moderately ill woman--and the decision they ultimately make about the importance of their relationship in the face of the man’s impending death.

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This is the wrenching history of the development, evolution, and eventual obsolescence of the leper colony established in 1866 on the isolated and only sometimes accessible peninsula on the Hawaiian island of Molokai--and the lives of the people who were exiled there to die over a period of more than 100 years. The tale opens with the declaration by the Board of Health that all persons proven (or strongly suggested) to be afflicted with leprosy be exiled immediately to the site on Molokai.

The author dramatically describes the selection and separation of the exiles from their families and the tortuous and sometimes deadly sea voyage to their primitive new homeland. Mixed with the public policy and the individuals who made and implemented it, are the descriptions of the hospital in Honolulu where diagnoses and dispositions were rendered, as well as the poignant personal stories of the "detainees." The reader follows the colony from the arrival of its first 13 patients in 1866, through its peak population of 1,144, to its residual 28 in 2003.

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Louis Drax is a nine-year-old boy living in France with his stay at home mother and Air France pilot father. Such an apparently normal family description is the merest tissue of appearances. The father is probably an alcoholic and unfaithful; the son is "accident-prone" (a nearly fatal episode of SIDS at two weeks of age, a near fatal electrocution at age 6 after falling on the tracks of the métro in Lyon; salmonella, tetanus, botulism, meningitis, etc. [or, as Louis is fond of saying, "blah, blah, blah."]) and the mother has issues that only emerge as one becomes more deeply involved in what is a mystery story.

Like Gabriel Garcia Marquez’s A Chronicle of a Death Foretold, or Janet Lewis’s superb The Trial of Søren Qvist, one knows the ending early on (page 16 in Louis Drax), but not the details. The why and the how are the stuff of the novelist’s art in all three books.

With premonition of more danger, Louis goes on a family picnic (see below for the author’s biographical basis for this tale) and winds up at the bottom of a ravine, dead. Drowned and dead. A few hours later, in the morgue, he is found to be alive. Comatose and in a persistent vegetative state but alive. He is therefore transferred to the care of a neurologist specializing in comatose patients at the Clinique de l’Horizon (formerly l’Hôpital des Incurables).

It is here that the mystery unfolds. The questions are: How did Louis end up at the bottom of the ravine? Did his father, now missing, push him as his distraught mother alleges? What role does the clearly neurotic mother play in this tragedy? And who exactly is Louis Drax? Lastly, how do the mysterious letters allegedly from him, written while still in a coma, come to be?

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This volume belongs in the category of cross-cultural studies of medicine and the humanities. Its main audience is scholars of nineteenth-century American psychiatry and culture. The author divides his study into six chapters, each with a topic, including the simultaneous emergence of nineteenth-century public debate about improving the treatment of insanity and the movement to abolish slavery; cultural activities in asylums directed toward humanizing the patients; bardolatry in British and American medical circles; discussions of Emerson, Hawthorne, Poe, and Melville in the context of their literary and personal relationship with madness; a chapter on captivity narratives and popular novels by former female and male patients; and an epilogue.

Unlike today, "In mid-nineteenth-century America, the condition of the mentally ill seemed to demand-and to a large degree received-national attention and the full creative energy of a group of dedicated reformers" (p. 2). Reformers linked the emancipation of slaves with curing the delusions of the insane. Slaves and the mentally ill had in common deprivation of their civil liberties; however, the difference was that white mental patients could be expected to grow up eventually, whereas black slaves would always remain children, and hence could not be trusted with the right to vote, own property, or sign contracts.Some causes of insanity were deemed to be the individual's reaction to the stress of modern life, too much freedom and choice, religious fervor, masturbation, or excessive study. In their aggressive attempts to remake patients into proper gentlemen and ladies, the new asylums promoted cultural activities such as reading selected texts, theater performances and writing.

Most asylums housed males and females in approximately equal numbers; cultural activities for females stressed piety, fashion, and domestic activity while men could comment on politics, the temperance movement, and opposition to women's rights. Reiss refers to the French model of using cultural activities in asylums, f.ex., Philippe Pinel's staging of plays to educate patients, and Marquis de Sade's theater performances at Charenton. He ends with a discussion of patient narratives that depict some horrific abuses tolerated in nineteenth-century asylums; the degree of these abuses is familiar to us from One Flew Over the Cuckoo's Nest (see film annotation).

The work includes a few illustrations, the most important being an engraving from a painting by Tony Robert-Fleury titled: Pinel Freeing the Insane (1876). (Yale University). Philippe Pinel (1745-1826) was a French pioneer in the humane treatment of mentally ill patients. A Director of Bicêtre Hospital in Paris, he is depicted as a heroic physician, liberating, mostly female, patients there. However, scholars have shown that only 10 of the 270 patients were chained, and that Pinel '"accepted the traditional use of chains to restrain the violent insane as a matter of course"' (p. 160). Reiss's point is that the revolutionary nature of Pinel's treatment of the insane has been exaggerated.

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Titicut Follies is the first major, full-length documentary by Frederick Wiseman, generally considered to be the most successful independent filmmaker in the United States.  Titicut Follies (the title of the film is taken from an annual talent show produced by inmates and staff) was filmed at the Massachusetts Correctional Institution in Bridgewater, Massachusetts, a sprawling facility of four divisions with four distinct populations.  Of the two thousand men warehoused there in the 1960s, only fifteen percent had ever been convicted of a crime, yet the institution was administered by the Department of Corrections rather than the Department of Mental Health--units representing very different and contradictory goals.  At the time of the filming, there were only two psychiatrists and one trainee caring for the six hundred men in the hospital section. 

Wiseman believed that public awareness of the terrible conditions at Bridgewater would create a demand for reform and improvement, and he gained unlimited access to the facility by representing the project to administration and staff as educational.   The result is a bitterly critical, shockingly brutal documentary account of the prison hospital, and despite giving Wiseman permission to make the film, the Commonwealth of Massachusetts quickly moved to ban its release.  In September 1967, just days before it was scheduled to be screened at the New York Film Festival, the attorney general filed an injunction that would permanently forbid Wiseman from showing the documentary to any audience.  In 1969, the Massachusetts Supreme Court permitted limited use for doctors, lawyers, health-care professionals, social workers and students, and in 1991, the courts finally allowed its release to the general public.  Titicut Follies is the only American film whose use has had court-imposed restrictions for reasons other than obscenity or national security.

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One of Steinbeck's earliest published works, The Pastures of Heaven is a collection of stories about the inhabitants of a fertile valley in California, beginning with the Spanish corporal who first stumbles across the "long valley floored with green pasturage on which a herd of deer browsed" and concluding with the families living there during the first stages of the great depression.  Most of the stories take place in 1928-1929, although many are rooted in flashbacks and narratives that span the generations before.  

The novel consists of short stories that describe particular times and places within the valley, and collectively form multiple different perspectives on life there; they are linked by the valley but also by the relationships between the families, and in particular, the Munroes, whose pleasant, mild appearance in almost every story heralds disaster.

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Suzanne Poirier has studied over 40 book-length memoirs describing medical training in the United States. These texts vary in format from published books to internet blogs, in time (ranging from 1965 to 2005), and in immediacy, some reporting during medical school or residency while others were written later--sometimes many years later.

A literary scholar and cultural critic, Poirier analyzes these texts thematically and stylistically, finding pervasive and regrettable (even tragic) weaknesses in medical education. Her three major points are these: such training (1) ignores the embodiment of future doctors, (2) is insensitive to the power relationships that oppress them, and (3) makes it difficult to create a nurturing relationship--especially by tacitly promoting the image of the lone, heroic physician.

While some of these repressive features have improved in the last decade or so--in contrast to the momentous scientific progress--there is a general failure to deal with the emotional needs of persons in training as they confront difficult patients, brutal work schedules, and mortality, both in others and in themselves.

In her conclusion, Poirier describes some contemporary efforts to help medical students write about their feelings, but she also sees the negative consequences of "an educational environrment that is inherently hostile to such exercises" (169).  Her challenge is this: " "Emotional honesty is a project for all health professionals, administrators, and professional leaders" (170).

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Body Language, a beautifully crafted and expansive memoir by retired nurse Constance Studer, spans a range of issues within the narrative of the author's life: a childhood marred by a medical procedure--a hasty frontal lobotomy that left her father incarcerated in a mental institute-- and, in later years, by her own illness, one caused by the Hepatitis B vaccine.  These two events are the bookends that frame Body Language, a memoir that examines family life, nursing, medicine, medical ethics, personal survival and illness in language that is poetic and compelling.  Studer, a writer as well as a nurse, intersperses her own story--which is novel-like in its intensity--with literary allusions, research material and knowledge culled from her years as a nurse in Intensive Care.  In her memoir, she writes not only with the authority of one who has been on both sides of the bed, as professional caregiver and as suffering patient, but also as a family member who has witnessed how unwise and unchallenged medical decisions might affect generations. 

What I especially admire about this memoir is that it is not simply a "telling about."  Instead Studer brings us into the action of the narrative, for example giving us imagery and dialogue as her father prepares for the surgery that he doesn't know will deprive him of memory and sense ("Holy Socks" p. 21).  She also intertwines many narrative strands, giving us the fullness of her family history and her professional adventures, so that when we reach the narrative of her own illness we have a sense of a life, a full life, that has been forever altered.

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A Place Called Canterbury by social historian Dudley Clendinen, former New York Times national correspondent and editorial writer, provides readers with an intimate and revealing account of aging in a particular place at a particular time--Canterbury Tower in Tampa, Florida. The story about the author's mother, Bobbie--and so many others--begins in 1994, a few years after the death of James Clendinen, Bobbie's husband of 48 years, and known to the community as the progressive editor of the Tampa Tribune. Although she had been "falling apart, a piece here, a piece there...collapsing vertebrae...bent, frail, and crooked...subject to spells and little strokes...." (p. xii),

Bobbie Clendinen was in reasonably good health. Nevertheless, her grown son and daughter did what most children their age do--they worried. When she finally agreed to move from the home where she had lived for twenty-nine years to Canterbury Towers, room 502, two bedrooms, two baths ($88,000 in cash, $1505 each month), Clendinen and his sister were relieved. She would be cared for and safe in "the small, cream colored, obsessively well-run geriatric apartment tower and nursing wing...across a broad boulevard from an arm of Tampa Bay" (see book cover).  And, so many of her old friends were already established residents!

Clendinen was fascinated by his mother's new circumstance and by what he came to regard as the new old age. As a writer, he could not resist the opportunity before him. Although he lived in Baltimore, he could come and go, but over the twelve-year period of his mother's residence--three in the Towers and nine years in the hospital wing--he spent more than 400 days as a live-in visitor, observer, listener, interpreter. This unusual arrangement provided Clendinen with a close-up view of a 21st Century phenomenon, the comings and goings of aging people in the final setting of their lives.

Canterbury is a well-run camp and life there is a soap opera. Between his exchanges with the witty rabbi and the former jitterbug champs, the enthusiasm generated by a nudity calendar proposal (declined) and the geriatric bib enterprise (thriving), the inhabitants provided Clendinen with an abundance of riches. Whether at lunch in the dining room overlooking the Bay, over daily drinks at 5pm, or in bed in the health center, everyone of this Greatest Generation had a story to tell. This ethnographic page-turner, with its cohort of named characters--the Southern Belle, the Rabbi who escaped the Holocaust, Emyfish, the ageless New Yorker, Lucile, the warm-hearted Fundamentalist, the raunchy Atheist, the crusty Yankee, the horny widower, and the maddeningly muddled Wilber--reads like fiction. Whether rich or poor, married or widowed, Clendinen listened as they spoke and in doing so became a trusted friend and chronicler of small and great events in their collective lives: childhood, Depression, World War II, medical advancements, healthcare costs, 9/11. Because Bobbie Clendinen spent so many years in the hospital wing, much of the story describes the kind of care and staff standards that we would hope for all--including ourselves. Mrs. Clendinen died at age 91.

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