Summary:

Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).

The book is divided into Introduction, five chapters on specific memoirs, and Conclusion. Chapter 1, "Patients and Biopower: Disciplined Bodies, Regularized Populations, and Subjugated Knowledges," draws on Foucault's theory of power to discuss two mid-20th-century memoirs of institutionalization for tuberculosis. Betty McDonald's the Plague and I is compared with Madonna Swan: A Lakota Woman's Story. Dividing practices and regularization are shown to serve different functions in these two incarcerations, figurative in the case of Betty McDonald, and literal in the case of Madonna Swan.

Chapter 2, "Politicizing Patienthood: Ideas, Experience and Affect," draws on Foucault's approach to the subject and on his discussion of "practices of the self" in contrasting Audre Lorde's The Cancer Journals with Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (see annotations). Diedrich also brings into her analysis Eve Sedgwick's theory of queer performativity and Sedgwick's own illness narrative, White Glasses. Diedrich views all of these as counter narratives to the clinical medical narrative of illness but she shows how they differ in stance.

Chapter 3, "Stories For and against the Self: Breast Cancer Narratives from the United States and Britain" looks at "the arts of being ill" as they are represented in two cultures, two "conceptions of the self in these countries at a particular historical moment" (61). The narratives discussed are Sandra Butler and Barbara Rosenblum's narrative, Cancer in Two Voices and Ruth Picardie's Before I Say Goodbye (see annotations). Diedrich associates Cancer in Two Voices with an American notion of self-improvement and Before I Say Goodbye with a British "emphasis on the cultivation of an ironic self" (55). The author works in this chapter with Freud's idea of the uncanny, Benedict Anderson's concept of "imagined political communities" and Elaine Scarry's discussion of pain, language, and the unmaking of the self.

Chapter 4, "Becoming-Patient: Negotiating Healing, Desire, and Belonging in Doctors' Narratives," treats Oliver Sacks's illness narrative, A Leg to Stand On, Abraham Verghese's autobiographical My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS, and Rafael Campo's book of essays, The Poetry of Healing (see annotations). Here Diedrich considers "the possibility that doctors, especially AIDS doctors, might become patients through desiring-and writing-productions" (83) and she utilizes the rhizome model of Deleuze and Guattari to make her case. She discusses how Verghese and Campo are each both cultural insiders and outsiders and how they each "bring the body into language through their writing" (88).

Chapter 5, "Between Two Deaths: Practices of Witnessing," focuses primarily on Paul Monette's writing about the loss of his partner to AIDS, and on John Oliver Bayley's books about the loss of his wife, Iris Murdoch, to Alzheimer's, and her ultimate death (see annotations in this database). In this chapter Diedrich invokes Lacan's concept of the real and his formulation of "the ethical possibility of being between two deaths" (117). She draws also on trauma theory and the work of Kelly Oliver, a contemporary feminist philosopher who has written on witnessing.

Finally, in her "Conclusion: Toward an Ethics of Failure," Diedrich returns to Elaine Scarry's "phenomenological discussion of the experience of pain" and brings in Jean-François Lyotard's concept of incommensurability and his suggestion between the two poles of what is seemingly incommensurable one might search, in Diedrich's words, for "new rules for forming and linking phrases between . . . subject positions" (150). In that context she analyzes physician Atul Gawande's discussion of medical uncertainty and error in his book, Complications (see annotation) and philosopher Gillian Rose's book, Love' s Work. Diedrich concludes that the basic incommensurability between doctor and patient can be a starting point for a new ethics, an ethics of failure and risk "because by taking such risks [of failure, of relations], we open up the possibility of new routes, new treatments: in and between art, medicine, philosophy, and politics" (166).

View full annotation

Summary:

This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.

The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).

In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.

View full annotation

Summary:

Thin, a documentary film produced, aired and distributed by HBO, is the centerpiece of a multi-faceted project that explores the complex issues of body images and eating disorders in young women. Photographer and journalist Lauren Greenfield began documenting eating disorders in 1997, eventually publishing an article for Time Magazine and a book entitled Girl Culture, as well as producing a traveling photographic exhibit. Returning to one of the facilities featured in the exhibit, Greenfield took up residence at the Renfrew Center, an in-patient facility for eating disorders in Florida, to film the day-to-day suffering of four young women struggling with anorexia over the course of six months.

The youngest is Brittany, a sad and troubled fifteen-year old, whose bulimia and anorexia began when she was only eight (her weight bounced from 185 to 95 pounds in one year) and whose mother has her own very unhealthy relationship to food. Brittany is eventually returned to her weight-obsessed mother because of the loss of insurance. Shelly, a twenty-five year-old, psychiatric nurse, has been anorexic for six years and enters Renfrew at 84 pounds with a surgically-implanted feeding tube. Her identical twin visits to plead with Shelly to refrain from slowly killing herself and ultimately destroying their family. Polly is a twenty-nine year old, charming troublemaker whose health is returning but whose defiance of rules eventually gets her kicked out of the facility. The oldest patient is Alisa, a thirty-year old, divorced mother of two whose eating disorder ostensibly developed at age seven when a pediatrician persuaded her mother to put her plump daughter on a severe diet. Alisa's graphic account of a single day of binging and purging is shocking, and her forced release from Renfrew because of problems with health insurance precipitates a return to this pattern after she tucks her children into bed.

 

View full annotation

Summary:

Born in Vienna, Alma Rosé (1906-1944) was a gifted violinist with an illustrious concert career. Her mother was the sister of composer, Gustav Mahler, and her famous father, Arnold, conducted orchestras. All the family members were non-observant Jews. Alma was talented, beautiful, audacious, and arrogant. After an unhappy early marriage to Czech violinist Vása Príhoda, she established a remarkable orchestra for women that toured Europe.

As the German Third Reich consolidated its power, her only brother, Alfred, fled to the USA. She managed to bring their widowed father to England, but displaced musicians crowded London making work difficult to find. Alma left her father and returned to the continent, living quietly as a boarder in Holland and giving house concerts when and where she could. She took lovers.

Despite the urging of her family and friends, she kept deferring a return to safety in England. In early 1943, she was arrested and transported to Drancy near Paris, thence to Auschwitz six months later. Initially sent to a barrack for sterilization research, she revealed her musical brilliance and was removed to marginally better accommodations and allowed to assemble an orchestra of women players.

The hungry musicians were granted precarious privileges, but Alma became obsessed with their progress and insisted on a grueling schedule of rehearsal and perfection. Some said that she believed that survival depended on the quality of their playing; others recognized that the music, like a drug, took her out of the horror of her surroundings.

In April 1944, she died suddenly of an acute illness thought to have been caused by accidental food poisoning. In a bizarre and possibly unique act of veneration for Auschwitz, her body was laid "in state" before it was burned. Most members of her camp orchestra survived the war.

View full annotation

Summary:

This remarkable collection of short writings, introduced by renowned poet Naomi Shihab Nye, who visited the Sutterwriters (of Sutter Hospital in Sacramento, California) to offer a workshop, provides a broad, compassionate, imaginative window into the life inside and around an urban hospital. Patients, staff, and all interested in healing through writing are invited to come and participate-with an accent on the latter: no one is invited who isn't willing to write.

Chip Spann, the editor, came to Sutter Hospital with a Ph.D. in English, and has the privilege of coordinating this fluid community of writers as part of his work as a staffmember. His conviction, voiced in an engaging introduction, is that literature is a powerful instrument of healing--both the literature we read and the literature we create--and that the experience of literature belongs in community. The individual pieces are accompanied by photographs and short bios of contributors.

View full annotation

Summary:

A group of eight women gather for a joint consultation with Dr. Kailey Madrona who is a devotée and colleague of the research endocrinologist, Dr. Jerilynn Prior, a professor at University of British Columbia in Vancouver. Madrona explains that she has arranged for the unorthodox group encounter because she will be leaving practice to pursue graduate studies in medical history.

Dr. Madrona leads an open-ended discussion on the physiological changes associated with perimenopause. Following the controversial research of Prior, she emphasizes that the symptoms are owing to the unbalanced rise in estrogen levels during perimenopause—a period leading up to the cessation of menstruation and continuing for twelve months after the last flow.

Some women patients are skeptical, because they have been placed on estrogen ‘replacement” medication, or they have read that their symptoms are owing to the waning of estrogen. The doctor describes the results of various trials about supplmentary estrogen, including the 2002 Journal of the American Medical Association report. She invites them to keep detailed diaries of their cycles and symptoms.

One by one the women return for private consultation, physical examination, discussion and another follow up visit. Although they have reached roughly the same physiological moment in life, they are a diverse group with different symptoms and needs. Darlene, an angry nurse, is suspicious and non-compliant. Beverley, an Asian immigrant is still hoping to become pregnant. A lesbian wishes to control her moods and hot flashes. A very hard-working waitress needs to understand her strange lack of energy. A wiry, lean athelete wants to improve her performance and is irritated by the inexplicable alterations in her abilities. Others are plagued by sweats, nausea, or migraines. They all are confused about sex.

Dr. Madrona listens to them carefully, examines them with special attention to their breasts, not their genitalia, and recommends treatment with progesterone for everyone. She also urges weight gain for most and readily volunteers personal information about her own perimenopause. All but the nurse eventually comply and are relieved of their symptoms. At the end of a year they meet for a pot-luck dinner to celebrate their recovered health and thank their doctor. Beverley is pregrant.

View full annotation

Summary:

At fourteen, China Cameron is trying hard to be a good mother to her two-year-old daughter, conceived while China and her best friend, Trip, were "fooling around" at his house one day. Trip and China's disabled Uncle--her only parent since the death of her mother and her father's early abandonment-do all they can to help her stay in school and parent well. But the child contracts a respiratory infection and dies, leaving China not only devastated, but responsible for a large funeral bill: she insists on ordering the most beautiful casket in the catalogue and funeral services that turn out to be devastatingly expensive. To pay the bill, against the advice of Trip and her uncle, China begins working at the reception desk of a local "gentlemen's club."

Though the job requires that she wear skimpy and revealing clothing, and subjects her to the unwelcome attentions of inebriated patrons, she squares it with her conscience by hanging onto the belief that she is doing the best she can for her daughter. The terms of her employment, however, become more difficult as she is moved toward "dancing" on stage. When she finally decides to quit, she finds that the club is partly owned by the funeral director, who has a history of involving young women in her situation in debilitating debt.

A subplot follows the misfortunes of China's best friend, Yolanda, a young women in her twenties with several children by different fathers who is trying to realign her life after her youngest children are taken temporarily to foster care. Despite their various difficulties, the characters enter with compassion and imagination into each other's lives, and find ways to help one another. At the end of the story, China finally consents to visit her daughter's grave--something she has strenuously avoided--nd concedes to the necessity of coming to terms in a new way with her loss so as to reorient her life beyond funeral expenses, and go back to school with a reclaimed hope of a different kind of life.

View full annotation

Summary:

Cameron, 18, and her sister Allie, 15, have inherited their father’s large nose. Living in Los Angeles, at the epicenter of the entertainment industry, they are familiar with the social currencies of money and beauty. Their mother, a former film actress, auditioning again after years at home, is exceptionally beautiful. Cameron’s “nose job”—the rhinoplastic surgery her parents arranged for her when she entered high school—has changed her life; it is debatable whether altogether for the better. She is now popular and accepted, but also, after a history of rejection and peers’ mockery, fixated on the kinds of beauty that bring social acceptance. Her interest in photography dovetails with this fascination.

At just the time her parents decide to arrange for a similar “nose job” for Allie, who doesn’t want it, and would rather spend the summer at soccer camp, Cameron decides to use her savings, and her new legal freedom as an 18-year-old, to have breast augmentation. Her parents and most of her friends oppose it, her boyfriend most strenuously, who can’t understand why she would take the risks entailed to do something so clearly unnecessary. As the girls learn, their mother has, at the same time, decided to have a face-lift as a return-to-career move.

Both Cameron and her mother go through the surgery—Cameron at the cost of considerable pain in recovery and aware of the long-term risks and costs. Allie, on the other hand, after coming to know an aging actress who was once a beauty, makes an eleventh-hour decision to refuse surgery and with it, the impossible standards of beauty that seem to her to entrap so many like her sister.

View full annotation

Summary:

This book, designed to accompany an exhibition "on the frequently Excessive & flamboyant Seller of Nostrums as shown in prints, posters, caricatures, books, pamphlets, advertisements & other Graphic arts over the last five centuries," displays and comments on 183 illustrations associated with the art of quackery. As the title suggests, Helfand surveys the graphic material of quackery of England, France, and America during the modern period, although most of the material dates from the eighteenth and nineteenth centuries. In his introduction, Helfand discusses the uncertain boundaries between "regular" (now termed allopathic) physicians and their "irregular" or "empiric" counterparts--quacks.

Through the mid-nineteenth century, many practitioners of both sorts relied on pharmaceutical agents like mercury, antimony, and opium; developed trade symbols and packaging; and flaunted the honorific "Dr." and their affiliation with science. Many patients visited both regulars and irregulars, who might consult with each other. Some physicians even prescribed quacks' proprietary preparations. Helfand also notes differences, such as irregulars' lack of medical training, exaggerated advertising, refusal to disclose the contents of their products, and use of entertainment and sometimes even religion in their "medicine shows."

View full annotation

Summary:

The Agnew Clinic by Eakins was commissioned by Dr. D. Hayes Agnew's students at the University of Pennsylvania to celebrate the seventy-year-old physician's retirement as Professor of Surgery in 1889. It was unveiled at commencement 1 May 1889. The size of the painting, the largest Eakins ever created, is 84 3/8 x 118 1/8 inches. The artist painted the work in ninety days and received a fee of $750. Its frame carries this inscription in Latin: The most experienced surgeon, the clearest writer and teacher, the most venerated and beloved man.

Dr. Agnew (1818-1892), a Pennsylvania native, was a well-respected surgeon and educator who had served in two army hospitals during the Civil War. He was best known for his competence in removing bullets, but Eakins has chosen to show him performing a lumpectomy or partial mastectomy.

The surgeon is shown standing in an enclosure, having stepped back from the operation. He is lecturing to students, faculty, and spectators seated in the operating theatre. Dr. Agnew holds a scalpel in his left hand. He is wearing a white surgical gown.

Eakins has placed the operating table with the female patient in front of Dr. Agnew. Her hair and face are visible, the ether cone just above her chin. Her right breast and arm are shown; the left breast is being operated on. A sheet covers her lower body. The sheet beneath the patient carries the inscription: University of Pennsylvania. Between Dr. Agnew and the bed we see a closed case holding the sterilized instruments. The anesthesiologist and the surgeons all wear white. Dr. Agnew's nurse, Mary Clymer, stands by the patient's waist. She is dressed in a high white cap, white apron and black dress.

Eakins illuminates Dr. Agnew, the patient and her doctors, and the nurse. The spectators sit in semi-darkness, but they are individualized by face and posture. The painting contains about thirty small portraits of doctors. Most of the doctors and spectators have been identified by name (see site at University of Pennsylvania: http://www.archives.upenn.edu/histy/features/1800s/1889med/agnewclinic.html). Eakins is standing to the extreme right, listening to a doctor who whispers to him. Because of time constraints, Eakins's mini portrait was painted by his wife, the artist Susan Macdowell Eakins.

View full annotation