Summary:

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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This is another wonderful book from Dr. Sacks. The subtitle, “Tales of Music and the Brain,” is accurate: we have a charming and informative mixture of stories of patients and the neurophysiology that interprets how music is processed and performed. The book is synthetic in combining cases from his practice, other clinical reports, letters from correspondents, references to medical literature, and even Sacks’s own personal experiences with music.

Sacks finds that humans have a “propensity to music,” something “innate” in human nature, perhaps like E. O. Wilson’s biophilia. “Our auditory systems, our nervous systems,” he writes, “are indeed exquisitely tuned for music” (xi). Although humans have been involved with music for millennia, it is only in the last few decades that medical imaging (functional MRI, PET) has shown what areas of the brain are active when music is heard.

While humans routinely enjoy music, the book emphasizes unusual events and neurological patients, in short, departures from the norm. Sacks—himself a lover of music—reports on his own experiences with hallucinatory music and anhedonia (loss of pleasure) in hearing music. He describes going to hear the great baritone Dietrich Fischer-Dieskau but finding that he could not, on that day, perceive the beauty of the music. Another condition “amusia,” or loss of musical ability, can be chronic, acquired, or temporary.

Some patients have had injuries or diseases of the brain that change how music is perceived. A man hit by lightning is suddenly obsessed with piano music. Another man (who survived a brain infection) has amnesia about many things but can still make and conduct music at a professional level. The concert pianist Leon Fleisher visits Sacks to discuss his dystonia, or loss of muscle function in one hand (with implications for the brain). Rolfing and Botox helped him heal and he returned to two-handed performances.

Sacks discusses other phenomena that involve brain structures, for example, perfect pitch; persons with this ability have “exaggerated asymmetry between the volumes of the right and left planum temporale” (128). People who experience synesthesia (perceiving notes as colors) have cross activation of neurons in different areas of the brain. Professional musicians (and patients with Tourette’s) demonstrate cortical plasticity, that is they have expanded areas of the brain for particular uses. Children with Williams syndrome have brains influenced by a microdeletion of genes on one chromosome; they have some cognitive deficits and also a great responsiveness to music. For some conditions, the brain determines all; for others, behavior components are also important.

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Janis Caldwell, who practiced emergency medicine for five years before getting her Ph.D. in English, examines the philosophy and practice of nineteenth-century British literature and medicine in this book. In an erudite introduction, she explains what she means by the "double vision" of "Romantic materialism," "Romantic because [physicians and authors] were concerned with consciousness and self-expression, and materialist because they placed a particularly high value on what natural philosophy was telling them about the material world" (1). These writers' intellectual context, influenced by natural theology, was dualist, including both the Book of Scripture and the Book of Nature. Their methodology "tacked back and forth between physical evidence and inner, imaginative understanding" (1), giving rise to the two-part "history and physical exam" familiar to physicians today.

The book examines this dual hermeneutic in six influential sites over the course of the century. In Chapter Two, Caldwell reads early-nineteenth-century debates over vitalism in the context of Mary Shelley's Frankenstein, arguing against the materialist-spiritualist divide so often cited in that period. She also brings readings of the novel into line with contemporary theories of physiologic sympathy. Next, she turns to the enormously influential sage Thomas Carlyle, arguing that he broadens the body/soul model to include both natural and supernatural aspects of the world. Again rejecting the notion of a philosophical dualism that prohibits mixing differing approaches, she argues, both Carlyle and the anatomist Richard Owen enthusiastically endorse a more heterodox vision of the world, in which we learn from both natural and spiritual enquiry.

The fourth chapter reads Emily Brontë's Wuthering Heights in the context of contemporary popular treatises on children's health and child-rearing. Caldwell argues that Brontë's image of the Romantic child, as emblematized in Cathy and Heathcliff, and characterized as "a more social, empirical, physical, literal version of childhood," derives in part from the "domestic medical texts which function as a sort of secular scripture in the Brontë household" (74). She suggests that the dualist language of natural theology, which combined spiritual and natural interpretation, and which was well-known in the Bronte household, influenced Emily's mixture of religious and medical concepts in her portrait of Romantic childhood.

Chapter Five contrasts Emily Brontë's version of childhood to that of her sister, Charlotte Bronte, in Jane Eyre and Villette. Charlotte Brontë, argues Caldwell, inclines more to the professional version of medicine, less suspicious of physician authority and more likely to experiment (in her fiction) with alternative medical theories such as phrenology. In an extended discussion of theories of literalization and metaphor, using Ricoeur to argue that the literalization of a metaphor returns us to the fact but also reinvigorates the metaphor through its dissonance with the fact. Caldwell proposes that the supposed "coarseness" of Brontë's novels is linked to her use of literalization.

A chapter on Darwin posits that "Darwin's thought arises directly out of ... Romantic materialism" (117). Although by the end of his life Darwin had renounced literary reading, the "dialectic of Romantic materialism" (shaped by Romantic literature as well as science) appears in "Darwin's preferred scientific method," in his rhetoric, and in the narrative structure of his scientific autobiography (123-24).

Caldwell's final chapter provides a significant new reading of the genre of the medical case history, by studying George Eliot's Middlemarch in the light of the bipartite structure of "the patient's narrative and the physical exam" (143). Emphasizing the negotiations between doctors and patients in the mid-nineteenth century, and calling for similar negotiations today, Caldwell navigates the differing critical positions on George Eliot's novel, weighing whether the narrator "participates in the systematic, totalizing knowledge of the pathologist" or undercuts that knowledge (156). Caldwell concludes that the narrator of Middlemarch practices a "hermeneutic circling" that shuttles back and forth between incommensurate perspectives, part and whole, nature and spirit, seeking "a partial and provisional, rather than absolute or positive, knowledge" (160). The book ends with a call to return the term "clinical" to its full meaning, not just of detachment, but of engaged practice.

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This book could perhaps have been called "Pathology and Identity in the Medical Case History and the British Novel." Tougaw here examines the mutual fascination of both nineteenth-century medicine and the British novel with pathology: that both "novels and case histories require a suffering body at narrative's center" (8), and that both "put into circulation a model of identity whereby the subject is always caught in a double bind... between health and pathology" (9). He examines developments in the medical case history, as a narrative, and argues that both this and the novel permitted an escape from "the nineteenth-century zeal for classification" (2). He reads the doctor-patient relationship as analogous to the reader-novel relationship, and argues that both genres must balance competing modes of approach: diagnosis and sympathy.

The book focuses on "controversial or marginalized maladies" (18), with each chapter acting as, itself, a case study. The first chapter, however, sets up Tougaw's critical terms of diagnostic and sympathetic reading, alternatives that help readers negotiate their discomfort with controversial conditions. The second chapter examines how the rhetoric of disability helps provide cover for "scientific scrutiny" (19) in cases of breast cancer, which bring to the foreground concerns over the limits and gendering of privacy and the body. Chapter Three builds on Peter Logan's work on the nervous narrator, examining Jane Austen's use of indirect discourse to finesse questions of hypochondria, compulsive storytelling, and early-nineteenth-century medical knowledge.

The fourth chapter focuses on the mid-century debate over mesmerism and anesthesia, reading cases alongside relevant novels by Wilkie Collins, Sheridan Le Fanu, Robert Louis Stevenson, and Mary Elizabeth Braddon. It traces Victorians' interest in altered consciousness and the effects of drugs on agency, and it argues for an analogy between the intersubjective relations of mesmerist/subject, doctor/patient, and narrator/reader. The final chapter reads Freud's "Rat Man" and "Wolf Man" against three novels by William James. Tougaw sees both these authors as putting forward a complex epistemology based on interpretation and intersubjectivity rather than assertion or individuality. The Afterword reframes Tougaw's arguments in the context of contemporary debates over the doctor-patient relation and the patient narrative; that "the real work of autobiography is the establishment of an intersubjective rapport between writer and reader" (21).

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Two hospice nurses describe their work with dying patients, especially with the special forms of communication typical of dying patients. The authors define "Nearing Death Awareness" as patients' knowledge and expression about their own dying. What doctors and family members may assume is the patient "losing it" or "hallucinating" actually is often a kind of symbolic communication dying patients typically use, either to describe their dying experiences or to request something they need for a peaceful death (such as seeing a loved one). By dismissing the patient as "confused," caregivers miss the opportunity to help the patient and may also alienate and frustrate both patient and family. By being aware of what is going on, caregivers can be more responsive and comforting to the patient and the family.

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In 1999, eighteen years after Project HOPE began publishing the journal "Health Affairs," the founding editor, John Iglehart, began a new column: Narrative Matters. This book contains 46 of the 80 essays published to date, and an inspiring foreword by Abraham Verghese. The essays are contained in eight chapters-- "Writing to Change Things: Essays on the Policy Narrative," "Dollars and Sense: Hard Financial Realities," "Bearing Witness: Patient's Stories," "The Maddening System: Frustrations and Solutions," "Trouble in the Ranks: Professional Problems," "Drug Resistance: Battling Undue Influences," "Disparity Dilemmas: Stories on Race and Ethnicity," and "Values and Choice: Stories of Practical Ethics." Familiar voices include those of Fitzhugh Mullan (one of the editors), Abigail Zuger, Howard Brody, Richard Lamm, John Lantos, Danielle Ofri, and Carol Levine. The essays in the first section strike an important cautionary tone, reminding readers that the plural of anecdote too often is taken for policy and that the repetition of anecdote should not be seen as evidence.

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John Grogan's best selling memoir of his and his family's life with an exuberant, loving Labrador retriever pup that grew into an overly boisterous ninety-seven pound member of the family chronicles the joys and tribulations of dog ownership. Particularly, of Marley ownership. Marley flunked obedience school, required tranquilizers to tolerate thunder storms, destroyed possessions and jumped on people, to name a few traits.

The young married couple adopted Marley before they had children. The reader learns of the pregnancies and births of the Grogan's three children, including a miscarriage, ‘performance failure' during sex timed to ovulation, and an episode of post-partum depression, with an eye to what Marley was up to during that phase of family life, and especially how he responded to his owners' emotional states. Marley's protective stance towards not only the children, but also to a knifing victim in the neighborhood and to Grogan himself when he was struck by lightning, proved the dog's loyalty and devotion.

Marley lived a full life; as he aged, his hearing, sight and mobility worsened. He required emergency abdominal surgery at an old age, recuperated, but then suffered the same stomach bloat and twist problem again.

Grogan, a newspaper columnist, decided, after a period of intense grief, to write an article about Marley. "‘No one ever called him a great dog - or even a good dog. He was as wild as a banshee and as strong as a bull. He crashed joyously through life with a gusto most often associated with natural disasters...' There was more to him than that, however... ‘He taught me to appreciate the simple things...And as he grew old and achy, he taught me about optimism in the face of adversity. Mostly, he taught me about friendship and selflessness and, above all else, unwavering loyalty.'" (p. 279)

The column generated an avalanche of responses; fellow owners of bad yet lovable dogs wrote to the newspaper of their own experiences. These responses were cathartic to Grogan as he and his family learned to live without Marley, the dog who had taught them all so much: "the art of unqualified love." (p. 287)

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Part of a series, "Letters to a Young . . . [fill in the career]," this collection of essays by pediatrician-author Perri Klass is addressed to her son Orlando during the recent period when he was applying to medical school. The essays follow a chronological sequence, beginning with the decision to apply to medical school, the first two years of medical school, learning how to examine and talk to patients, residency training, physicians as patients, making mistakes, grappling with the most fundamental human issues in medicine, and the mingling of professional work and life.

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In this compelling memoir, Grace, a writer, artist and teacher, unexpectedly finds herself attracted to a carpenter, Howard Staab, whom she meets when looking at a new home. Shortly after their relationship begins, Staab is told in a routine physical examination that he has severe mitral valve regurgitation and will require surgery. Staab, an active, otherwise healthy fifty-three year-old man, has no health insurance. The cardiac surgery will cost over $200,000. Thus Staab and Grace embark on a quest to find an affordable, but excellent surgeon and hospital. Grace details her efforts to find the best care possible, including correspondence with her son, Bryan, a Stanford medical student with interests in international health. These inquiries lead to the possibility of surgery in India.

After a useful, explanatory preface the book begins when Staab and Grace land in New Delhi and enter the Escorts Heart Institute. Staab undergoes a series of tests confirming the need for surgery, which is subsequently performed by Dr. Naresh Trehan. Through Grace's eyes, we also meet nurses, aides, other physicians, administrators and friends. The narrative follows the hospitalization, including dramatic complications and eventual recovery, and also backtracks to better detail the search for care and the predicament of un- and underinsured Americans. Grace also describes the post-hospital phase, including venturing out beyond hospital and hotel walls.

The book, highlighting the fact that Grace and Staab face more than one cultural challenge in this journey, contains both a medical terms glossary and a short list of Hindi terms. Ultimately, Grace concludes she would consider returning to Escorts or a similar hospital should she or a loved-one require surgery, even without the insurance issue. She states: "India, the land of contradictions. Organized chaos. A third-world country with first-world state-of-the-art medical care available for a fraction of the cost of the same procedures here in the U.S." (p. 259)

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Author and teacher Peggy Shumaker was involved in an unexpected and terrible biking accident.  Out of that accident and her following slow recovery she has crafted a remarkable memoir---one that both examines her interactions with the medical community and her family and charts her return from disability---in short essay-like chapters, individual memories that comprise and inform her life before and after illness.  Reading these gem-like pieces, I could imagine her, in the process of recovery, having time and patience to look back at family, friends, custom and community in order to recreate who she was before and who she would be after her accident.  The longest of these "chapters" is several pages; the shortest, only a few sentences.  There is no table of contents guiding readers through the six sections of this book---and how could there be, as the book itself reflects the healing mind as it searches for continuity in the midst of disruption. 

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