One Friday in April

Antrim, Donald

Last Updated: Feb-08-2022

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

As One Friday in April opens, we find Donald Antrim in an agitated state on the roof of his Brooklyn apartment building. He paces, and alternately climbs down the fire escape, hangs from the railing, and lies on his stomach peering over the ledge. Repeated outpatient courses of psychotropic medication and psychotherapy have done only so much for his deteriorating mental state, and the situation has come to a head. Disheveled and wild-looking, he manages to return home whereupon his friends take him to a psychiatric hospital.

A MacArthur Fellow and author of several acclaimed novels, Antrim has previously published a memoir of his upbringing with his alcoholic mother. In this new memoir, flashbacks of childhood neglect and chaos are juxtaposed with the present day as he takes the reader through the acute phase of his illness: a lengthy hospitalization, a course of ECT, discharge from the hospital, rehospitalization, and eventual stabilization.

The author considers his condition to be suicide, noting that “depression is a concavity, a sloping downward and a return. Suicide, in my experience, is not that. I believe that suicide is a natural history, a disease process, not an act or a choice, a decision or a wish…I will refer to suicide, not depression” (pp. 14-15).

The book ends on a hopeful note. After several relationships that might be described as codependent, Antrim meets his current partner, whom he marries. He sees the roof of his building through his window and remembers a certain Friday in April but is comforted by the sound of his wife playing Chopin and Bach on the piano.

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The Problem of Alzheimer’s

Karlawish, Jason

Last Updated: Nov-29-2021

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5). He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease.

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease.

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections.

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How To Be Depressed

Scialabba, George

Last Updated: Nov-28-2021

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

How To Be Depressed is a book with a most unusual structure. It is introduced by an essay entitled “Intake” that was previously published in a literary magazine. The bulk of the book, “Documentia,” is taken up by an edited selection of the author’s psychiatric records from 1969 to 2016. It is rounded out by an interview with the author and by his “Tips for the Depressed.”

Author George Scialabba ascribes his “exceptionally flimsy…shock absorbers” to his “constantly worried” parents (p.3). While studying at Harvard he becomes involved with a strict religious organization. After leaving that group he undergoes a crisis of faith and his first episode of depression. Paralyzed by self-doubt, he drops out of graduate school and begins a cycle of clerical jobs that are beneath his intellectual capability. After many years he gradually wins distinction as a freelance essayist. However, due to his incapacitating symptoms he never has a steady writing job and has difficulty attaining financial security.

In his introduction, Scialabba tells us that “the pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything” (p.1). As attested to by the notes of his well-meaning psychiatrists and psychotherapists, he has diligently applied himself to a wide variety of treatments. Sadly, if anything he gets worse over time, and eventually requires electroconvulsive therapy.

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Blood in the Water: The Attica Uprising of 1971 and its Legacy

Thompson, Heather Ann

Last Updated: Nov-09-2021

Trachtman, Howard

Primary Category: Literature / Nonfiction

Genre: History

Summary:

1971 seems like a very long time ago. Richard Nixon was President, the Vietnam War was still raging, and China and Russia were the sworn enemies of the United States. Fifty years have passed, and at first blush, the world seems like a different place. Unfortunately, the more things change, the more they can stay the same.

One of the most horrifying events of that year was the prisoner revolt at the Attica State Prison in upstate New York in early September. I did not live in New York at the time and have only a vague recollection of reading the newspaper reports of what happened. But ask anyone living in New York who was at least 15 years old at the time and they will tell you that they have vivid memories of what transpired over the five days from September 9-13. In this extraordinary book, Heather Ann Thompson recounts in all its gory detail the prisoner uprising, the bloody retaking of the prison by state troopers, and the nearly thirty years of investigation and legal wrangling that occurred in its wake.

By the late summer of 1971, there had been prisoner rebellions in state penitentiaries across the country including a nearby high security facility in Auburn NY. There was increasing tension and escalating prisoner protests against the inhumane conditions in all prisons including overcrowded cells, limited access to food and fresh air, and routine brutal treatment at the hands of the correction officers. Finally, Attica prison erupted on September 9 after a minor skirmish between guards and prisoners. The prisoners took 38 hostages and over a thousand prisoners escaped their cells and crowded into the prison yard. They created a communal space to take care of each other that was equipped with meager resources. There was a central meeting area for the leaders of the uprising. They created a human shield around the hostages to protect them from harm.

Over the next four days, there were intense negotiations between prison officials and the prisoners. A team of observers including Tom Wicker was bought in at the request of the prisoners to serve as witnesses and act as potential mediators. Finally, after negotiations fell apart over the prisoner demand for amnesty, without warning, the troopers dropped tear gas cannisters from helicopters and stormed the yard. Tragically, when the dust had settled, 32 prisoners and 11 hostages had been killed by bullets fired by the troopers. This terrifying sequence of events is described in the first third of the book. The remaining part details how prison wardens destroyed critical forensic evidence and collaborated with state politicians up the chain to Governor Nelson Rockefeller’s office to portray the events as a successful suppression of a radical-supported attack against the state. They solicited false testimony and pursued a one-sided prosecution of the prisoners for the murder of one guard and several prisoners. There are too many villains in the story but also some true heroes – a coroner who refused to back down from his post-mortem examination showing that all the victims were killed by gunfire, knowing that only the state troopers had firearms. The prisoners who confronted the legal system, defense lawyers willing to take up the cause of the prisoners, a brave state lawyer who was an essential whistleblower, all were vital in the pursuit of truth. At the end, the justice system failed nearly everyone involved, and Attica Prison remained an important part of the New York State correction system. The only monument is a stone at the entrance to the prison memorializing the hostages who died.

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This is Your Mind on Plants

Pollan, Michael

Last Updated: Oct-21-2021

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Investigative Journalism

Summary:

Michael Pollan is curious about human consciousness and how humans alter it using a variety of molecular compounds. This curiosity took him first to three mind-altering psychedelic drugs: psilocybin, lysergic acid diethylamide (LSD), and 5-MeO-DMT (“The Toad”). He reported his findings and personal experiences in a 2018 book, How to Change Your Mind. His curiosity yet untamed, Pollan expands his project to three mind-altering compounds found in plants: opium, caffeine, and mescaline in his latest book.

Pollan’s investigation is born of his vocation as a gardener “fascinated by our attraction to these powerful plants as well as by the equally powerful taboos and fraught feelings with which we surround them.” He’s further attracted to them for the way in which when “we take these plants into our bodies and let them change our minds, we are engaging with nature in one of the most profound ways possible” (p. 3). The sources he chooses are the opium poppy for opium; coffee and tea for caffeine; and peyote and San Pedro cacti for mescaline.

Opium, caffeine, and mescaline represent the range of mind-altering properties available from plants of interest to Pollan. In opium he saw a sedative, in caffeine a stimulant, and in mescaline a hallucinogen, or as he characterizes them, the “downer, the upper, and the outer,” respectively (p. 4). Their effects on consciousness do not feature dissolution of the ego, as is the case with psychedelics, and indeed, they can solidify ego. Seemingly most important to his selection, however, was that,

Taken together, these three plant drugs cover much of the spectrum of the human experience of psychoactive substances, from the everyday use of caffeine, the most popular psychoactive drug on the planet; to the ceremonial use of mescaline by Indigenous peoples; to the age-old use of opiates to relieve pain. (p. 4)

The book comprises an introduction and a chapter each covering opium, caffeine, and mescaline. The introduction describes his dual interest in the ancient human drive to fool with consciousness, and in plants that produce mind-altering substances as evolutionary features. Pollan also touches on how civilizations, ancient and current, aid and combat the use of these substances, at times simultaneously. In the chapter on opium, Pollan updates his April, 1997 Harper’s Magazine article about his experience growing opium poppies as the war on drugs peaked in the mid-1990s; in this version he reconstitutes the section he left out for fear of arrest and conviction that has since abated. In the next two chapters, Pollan separately reports on how caffeine and mescaline affected his consciousness. Because he was already a heavy caffeine user, Pollan had to give up coffee and tea if he was to discern its mind-altering effects, but for mescaline’s mind-altering effects, he had to find a source, a setting, and a guide through the maze the Covid-19 pandemic created.

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The Impatient Dr. Lange: One Man's Fight to End the Global HIV Epidemic

Yasmin, Seema

Last Updated: Oct-06-2021

Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

The Impatient Dr. Lange is a biography of Joseph “Joep” Lange, an HIV/AIDS researcher best known for his work in HIV transmission prevention and treatment, written by Seema Yasmin. Yasmin is a journalist, doctor, and epidemiologist whose life path was forever altered by a run-in with Dr. Lange at age 17, when he said to her, “If you want to help people, first you need to learn how to take care of them. Go to medical school.” (p. xiii). The book’s narrative parallels that of the life of her inspiration, Lange; in addition, Yasmin details the evolution of HIV, how it came to spread around the globe, and a history of antiretrovirals.

Coming of age professionally in the early 1980s, Joep Lange had a career defined by HIV and the advances to manage it. Early on, he trained as a physician before pursuing a PhD. During his PhD, he was a prolific researcher, producing “eleven papers on AIDS in his first years,” including an early case study on the appearance of acute HIV and the way in which the body’s antibody response changes in response to continued infection. His commitment to rigorous scientific inquiry continued as a professional research scientist. Most noted for his early trials about the use of antiretrovirals and their role in preventing mother-to-child transmission of HIV, he was intimately involved with much of the science used to treat and prevent HIV today. Outside of research, he was an ardent advocate of health equity, starting the PharmAccess Initiative, a group initially developed to expand access to antiretrovirals in developing countries.

Ultimately, the book is about how a life of great potential, drive, and success was tragically cut short. Shadowing the narrative of the book is the specter of Lange’s unfortunate end on Malaysia Airlines flight MH17, a plane that was mistakenly shot down over the Ukraine by pro-Russian separatists, while he was en route to the twentieth International AIDS Conference in Melbourne. The penultimate chapter reflects on all that was unfinished - projects on three continents, advising the next generation of PhDs, a novel - and ends with a prescient quote from Lange, in regard to mandatory retirement in the Netherlands at the age of 65: that even if he had 10-15 more years, he declares “that is still not enough time” (p. 174).

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Everything is Fine

Granata, Vince

Last Updated: Oct-03-2021

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Vince Granata, the author of Everything is Fine, remembers feeling at the age of 4 that the day his triplet siblings were brought to their suburban Connecticut home from the hospital was the best day of his life. For many years, to all appearances, his was the perfect family.

Then, while in college, his brother Tim develops a psychotic disorder. Refusing treatment, he becomes more and more delusional. He speaks frequently about killing himself and is convinced his mother has raped him. Announcing that “demons are everywhere” (p.115) he enters his parents’ bedroom and throws salt at them as they sleep. His mother, though trained as an emergency physician, dismisses the idea he could become violent: “Everything is fine” (p.122).

When Vince receives a phone call that his brother has killed his mother, he rushes home from teaching abroad to find yellow tape surrounding the house. The immediate, surrealistic concern is to have a company clean the traces of his mother from the rug.

Over the next few years, Tim is treated to restore him to competency so he can stand trial. Vince and his father visit Tim faithfully in a facility while two other siblings cannot bring themselves to face him. A friend insightfully prophesies “I hope you will eventually be able to find some peace and feel whole again…though that might be your life’s work” (p. 149). Indeed, while his brother recuperates, Vince goes through his own healing process. He dedicates himself to understanding schizophrenia and the shortcomings in our mental health care system, and, finally, writes this book.

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The Empathy Exams

Jamison, Leslie

Last Updated: Aug-02-2021

Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

The Ministry of Bodies

O'Mahony, Seamus

Last Updated: Jul-26-2021

Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Starting eight months before his retirement, a gastroenterologist chronicles a myriad of encounters between himself and others - patients and their family members, colleagues, administrators, hospital staff, and even drug reps. He has worked for many years at a large Irish hospital dubbed the "ministry." His professional work there is divided between the endoscopy unit (where he performs colonoscopies and EGDs), medical wards, an outpatient clinic, and the ER.

Given his specialty, the roster of patients tilts heavily towards gastrointestinal problems: alcoholic cirrhosis, GI bleeding, chronic diarrhea, and abdominal pain. But additionally, his days are filled with patients presenting with a variety of medical problems including pneumonia, mental health issues, heart failure, serious fractures, dementia, seizures, anemia, and cancer. He attends to many frail elderly folks in the emergency department. His interactions with patients range from intense to jovial, from unexpected to heart-wrenching. For example, a woman with chronic abdominal pain asks the doctor if she might be suffering from PTSD. When asked why she thinks that might be possible, her reply is "My son hung himself. I found him" (p191).

The doctor is beleaguered by frequent, and at times wacky, emails generated by the hospital bureaucracy as well as unproductive meetings. He must cope with his own health problems too (a vitreous detachment, arthritic hands, and unexplained nosebleeds). He decries the "foolishness" of excessive medical testing and overtreatment and cites the case of a young woman with irritable bowel syndrome who already had over 1,200 test results logged in the hospital lab. He describes the ministry as "an oasis of kindness and comfort" but "also a place of chaos and conflict, of institutional cruelty" (p8).

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The Hospital: Life, Death and Dollars in a Small American Town

Alexander, Brian

Last Updated: Jul-14-2021

Carter, III, Albert Howard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Native Ohioan Brian Alexander cares a lot about his state and its many economic problems, especially as they impact healthcare. For this book, he’s an on-the-ground reporter covering the events in and around a hospital in the small town of Bryan from 2018 to 2020. He is also an in-depth interpreter, analyzing the many dilemmas of this small hospital and emphasizing that these represent parallel problems of social justice for all of contemporary American healthcare. An opening chapter reviews some of the difficult history of this area, including economic collapse, lack of public health, lack of health insurance, and collapse of jobs in supply chains for Detroit.

While the timeline of the story is short, it has wide breadth in local and national issues. These are illustrated by the stories of specific people. Marc Tingle, a local contractor has a heart attack; his wife falls ill and is diagnosed with cancer. Medical bills mount up. Marc has a second heart attack and a stent inserted. He, like many others receives “rescue” medicine, not preventive healthcare, due to social or economic issues beyond their control. Similarly, we read about Keith Swihart, overweight and diabetic. He has a foot ulcer that requires surgery and later partial amputation. He has eye problems that progress to near blindness. Valerie Moreno injures her back at work but does not report it to the company, considering herself tough, but she must have spine surgery. After being laid off, she has part-time jobs, money problems, and turns to OxyContin pills. These are dramatic and painful stories.

Many families make “just enough money to disqualify themselves…from Medicaid, but not enough to afford coverage offered by an employer or via the Affordable Care Act” (p. 242).

Such patients illustrate a deadly whirlpool of issues: lack of routine medical care, inadequate health insurance, no national health program, a collapsed economy with no good jobs or prospects of advancement, poor nutrition, pervasive poverty, racism, sexism, and more.

Amidst all this, we follow Phil Ennen, the CEO of this hospital (CHWC--for Community Hospitals and Wellness Centers) in Bryan. He wants to rely on his local, traditional values of “we can fix this,” but now he must confront the threats of national hospital chains, the need to cut staff and services, and the seductive lures of adding for-profit and high-tech services. Eventually, he sees no path forward and accepts the board’s invitation to retire. His replacement will have all the same problems.

A closing section sees the arrival of Covid-19, a threat to this hospital and, of course, the nation at large. Alexander writes, “the virus seeped into the fault lines created by American pathologies. The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit” (p. 268).

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