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Kay Redfield Jamison, An Unquiet Mind, Vintage Books, 1995. Reviewed by Harvey Fenigsohn (May 2011).

Location: Humanities in Medicine Collection
Call Number: WZ 100 J32 1995

"I doubt sometime whether a quiet and unagitated life would have suited me—yet I sometimes long for it." Byron

With the above quotation, Kay Redfield Jamison prefaces her autobiography, An Unquiet Mind (1995). Both the Romantic poet's sentiments and the author's title prove most appropriate. Like Byron, Jamison considered herself unsuited for a "quiet and unanimated life." Whipsawed by extreme mood swings, she felt destined for a tempestuous life- alternately energized and enervated, ecstatic and despairing, creative and destructive- the product of "an unquiet mind." Unlike the poet, however, Jamison discovered that a stable, calm, ordered life—even one Byron would "sometimes long for"- suited her best. In her engrossing autobiography, the author relates her brave struggle to overcome the life threatening mental illness of bi-polar disorder or manic depression.

Remarkably, as a clinical and research psychologist, Jamison became a leading authority on the very disease from which she suffered. Writing from the subjective view of a patient and the objective view of a clinician, Jamison sensed that her unique perspective could benefit those similarly afflicted with bi-polar disorder. However, as a professor of psychiatry at Johns Hopkins University, the author knew she could jeopardize her entire career, lose hospital privileges, valuable grant money, and a prominent position by forthright revelations about her mental illness.

Jamison felt relieved when her risky decision gained support from colleagues and the president of the Johns Hopkins Hospital, but she learned that disparaging attitudes toward the mentally ill continue to warp public perceptions:

The kindness and generosity of most people was heartening, the vitriol and irrationality from others disturbing. The subject of mental illness tends to bring out a complex humanity in people; in others, it hits a deep vein of fear and prejudice. Far more people then I had realized conceptualize mental illness as a spiritual flaw or a shortcoming in character (xii).

In writing her memoir, Jamison helped dispel this stigma of mental illness, achieving a kind of catharsis, and garnering praise for the excellence of her writing.

Indeed, Jamison's prose style -alternately plain spoken and lyrical, always graceful and lucid - serves her admirably. Well versed in literature, the author makes apt literary allusions. For instance, pondering the wisdom of writing a potentially incriminating autobiography, Jamison took "a certain solace in Robert Lowell's essential question, "'Yet why not say what happened?' "(viii). [Fittingly enough, Lowell, too, suffered manic-depression.] Jamison's language, exact and metaphoric, reflects the precision of a trained scientist and the sensibilities of a true poet. Here, in one of her hypersensitive manic episodes, she imagines herself as an insect:

The hospital-ordinarily a cold clotting of uninteresting buildings-became for me ... a focus of my finely wired, exquisitely alert nervous system. With vibrissae twinging, antennae perked, eyes fast-forwarding and fly-faceted, I took in everything around me (3).

Overcoming her disease and pursuing outstanding research ultimately rewarded the author with personal fulfillment and professional honors, but not without an agonizing struggle. For Jamison, like many other manic depressive patients, repeatedly wounded herself in the process of treatment. Despite a thorough medical knowledge of mental illness, the author became her own worst enemy- first denying her disorder and later refusing to comply with mood stabilizing medication. In this unsparing confessional, Jamison disclosed how she stubbornly sabotaged her recovery. She explained why she and a close colleague sharing the same disorder initially resisted medication:

We were deeply skeptical that they would work and wary of potential side effects ... Like many people who get depressed, we felt our depressions were more complicated and existentially based than they actually were. Antidepressants might be indicated for psychiatric patents, for those of weaker stock, but not for us. It was a costly attitude; our upbringing and our pride held us hostage (54).

Nearly destroyed by the illness, Jamison finally agreed to take the mood stabilizer, lithium. Nevertheless, despite lithium's beneficial effects, she often stopped taking the medication, subjecting herself to inevitable cycles of frenzied manias followed by crippling depressions. Quickly spending over $37,000 on frivolous purchases; impulsively attempting to leap from moving cars; exploding in violent rages at loved one - all characterized her bouts of full-blown mania. Then, her mind suddenly paralyzed, her will sapped, Jamison would plummet into a "depression ... flat, hollow, and unendurable" (218). Experiencing first-hand the effects of non-compliance afforded the psychologist special insights into the troubled world of her patients, but at an unaffordable price- one she nearly paid with her life when only a brother's last minute intervention prevented her suicide.

To help us understand how she reached this point of utter desperation, Jamison hearkens back to her almost idyllic girlhood, to her comfortable life as the privileged child of an Air Force officer. Her loving parents, conservative but open-minded, imbued their daughter with the self-confidence and strong moral values she would cherish as an adult. But she inherited, as well, a dark legacy- her father's unpredictable mood swing and his obstinate pride. Mercurial from her earliest days, at seventeen, Jamison's first encounters with the "quicksilver disease" (7) hardly prepared her for what was to come:

My manias, at least in the early and mild forms, were absolutely intoxicating states that gave rise to ceaseless energy that allowed the translation of new ideas into papers and projects (5).

While later episodes of the disorder proved far more damaging than beneficial, Jamison, like so many others, continued to find seductive the excitement of mania-the euphoric rush of intense feeling and boundless vitality so-called normal people never experienced. By book's end, with her disease under control, Jamison at times nostalgically yearned for what she relinquished:

There are still occasional sirens to this past, and there remains a seductive, if increasingly rare, desire to recreate the fervor and fever of earlier times (211).

Finally, despite the addictive exhilaration of mania, Jamison understood that nothing justified the devastating results of her psychotic interludes, especially the anguish she caused herself and those closest to her. Nor was the stultifying despair of the inevitable depressions worth enduring. Having destroyed a flourishing marriage, she now threatened a gratifying career. Every self-inflicted punishment made Jamison's disorder more intolerable. She at last felt compelled to defy her self-destructive impulses.

Taking full responsibility for her illness, Jamison accepted that sufferers of manic depression must manage their disorder in the same sense that diabetic s manage their diabetes-both life-long diseases never completely in remission. Complying with the lithium regimen and undergoing weekly therapy, she happily remarried, soon distinguishing herself for her contributions to improving mental health. Earlier, having founded UCLA's Affective Disorders Clinic, Jamison was awarded a tenured position as the Dalio Family Professor in Mood Disorders and Professor of Psychiatry at the Johns Hopkins School of Medicine.

Becoming a national authority on manic depression, Jamison co-authored the classic medical text, Manic Depressive Illness: Bi-polar Disorders and Recurrent Depression (2007). In addition to An Unquiet Mind, (1995), a best-seller, she wrote Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. (1996); Night Falls Fast: Understanding Suicide (1999); Exuberance: The Passion for Life (2004); and Nothing Was the Same: A Memoir (2009.) Granted a MacArthur Fellowship and an honorary doctorate from the University of St. Andrews, she was honored with numerous other literary and academic awards.

Jamison gratefully acknowledges those most instrumental in her healing including understanding coworkers, an extraordinary psychiatrist, loyal friends, a devoted family, and a loving husband. But the most credit goes to the author herself. At last, the healer healed herself. Revealing so eloquently how she quieted her unquiet mind, Kay Redfield Jamison serves as an inspiration to all who admire courage.

Paul Harding, Tinkers, Bellevue Literary Press, 2009 Reviewed by Harvey Fenigsohn (April 2011).

Location: Humanities in Medicine Collection
Call Number: PS 3608 A72535 T56 2009

The opening sentence of Tinkers, Paul Harding's Pulitzer Prize-winning novel reveals the novelist's ingenious talent. Harding tightly compresses a spring which, when released, propels his entire narrative. The compressed spring is the simple statement, "George Washington Crosby began to hallucinate eight days before he died" (7). This one, short declarative sentence thrusts forward all that follows. As we might infer from the opening sentence, the novel extends over the "eight days before he died," ending as George does. From the dying man's hallucinations, spring dreams, visions, and memories—the essence of a novel well worth reading. In Tinkers, his first novel, Harding meditates deeply about the meaning of time, memory, and mortality.

Handy, practical, and self-reliant, a quintessential American, George Crosby, one of the tinkers of the novel, once built his own home. Now, on his deathbed, "nearly a ghost" (7), he imagines his beloved construction falling apart, burying him as the whole universe collapses. Like the fallen house of the doomed man's fantasies, his mind and body disintegrate into "confused oblivion" (11). Moving smoothly from the real to the surreal, the author sounds a major theme: the impermanence of our lives, our mutability, our transience. Harding reflects on the fragility and vulnerability of all we create and all we are.

The author describes how George once sold and repaired antique clocks. These clocks become perfect symbols for Harding's concern with the inexorable limitations of time. As a skilled horologist, passionate about his work, George temporarily controlled time; "the imps of disorder are banished" (17). But the ticking of the precise machines now signals the finite limits of his time, as his organs, like the clocks he repaired, finally wind down. When George discovered that all the clocks in the room have stopped ticking, he demanded they be rewound. His grandson rewound them but it is too late for George; his time will soon be up. Harding finds a new way to tell an old truth about the killing power of time.

Harding describes an old man attempting to take stock of his life but envisioning only "a shifting mass, the tiles of a mosaic spinning, swirling ... independent now of his will, showing him a different self every time he tried to make an assessment" (18). George's sense of who he was, and who he is, now explodes into fragments of lost memory. Harding questions the puzzling nature of memory. How much does our sense of self, our very identity, depend on what we remember and understand of our past?

Through flashbacks Harding deftly weaves an account of George's present with indelible remembrances of his boyhood. George remembers that, seventy years ago, his father, Howard Aaron Crosby, the other "tinker" of the title, drove a horse drawn wagon through the New England countryside, selling dry goods and mending wares. The author relates much more of Howards' life than what George could know, but the flashback serves well as a narrative device to tell two stories at once. Transcending his deathbed delusions, George recalls poignant scenes of his childhood as the son of a father who abandoned him. It is these bittersweet memories which enable George to finally understand himself as he comes to understand and forgive his father. The author reveals the healing power of memory.

Harding's arresting language captures the hardscrabble lives of back woods farmers in the early 20th century—impoverished families driven nearly mad by the isolation of winter and the omnipresence of death: "they came to the wagon like sleep walkers: bright eyed and ravenous. Sometimes he came out of the woods with orders for a coffin - a child, a wife wrapped up in burlap and stiff in the woodshed" (12). With his control of language, Harding convinces us; we sense the verisimilitude of his settings, the authenticity of his characters.

Only Howard's reverence for the natural world relieved the drudgery of a nearly penniless tradesman. Pausing his wagon, Howard communed with nature, and imagined himself a poet. To help us sense Howard's delight in the beauty of his surrounding, Harding artfully transforms prose into poetry, "The bark of birches glows silver and white at dusk/The bark of birches peels like parchment/Fireflies blink in the thick grass and form halos around hedges."(55) These passages, alone, make Tinkers a novel to appreciate.

Howard suffered from epilepsy at a time when this disorder was little understood. Untreated, he endured unpredictable seizures and Harding's charged metaphors convey the intensity of these convulsions, "during his seizures . . . his brain nearly fried in his skull." (47). Harding describes how the attacks, striking like a lightning bolt, electrified George, granting him the intuition and insights of a visionary. But the author hardly romanticizes the disease of epilepsy as he describes "Howard's blistered brain" (47). Both brutal and tender, Harding's searing depictions of Howard's seizures realistically present the danger and pain of this disorder.

The author movingly dramatizes a scene when George's father literally and figuratively wounds his son, biting the boy's hand as George places a stick in the convulsing man's mouth. George comes to resent his father's very existence, but ultimately forgave his father, for even then, George had mixed feelings toward "a mad father whom he loved and pitied and hated" (113).

Howard also suffered a bitter wife with little sympathy for her husband's illness. Harding reveals her contempt for Howard in her cruel description of him as "a birdbrain, a magpie, a loony bird, flapping around with those fits" (20). When he discovered his wife's plan to commit him to an asylum, Howard fled, making a new life with an adoring wife.

Howard abandons his family, leaving them destitute, but Harding presents Howard's flight as an act of liberation. We see Howard redeemed by the transformative strength of love. He seems to forget his old family, but years later, the fugitive father makes one brief visit to his old family. Just before he dies, on the eighth day, George remembers that visit – comforted by his last memory of a lost father he never stopped loving. It's no accident that Harding makes George's final thoughts the memory of his father's visit. Father and son, separated for so long, finally reunite. At last, George can die in peace. So ends Harding's meditation on time, memory, and mortality.

Harding's work will not please every reader. Some will object to a novel so loosely plotted- a narrative interrupted by mystical descriptions of nature, the history and repair of clocks, the funeral of a mouse, and complete directions on how to make a bird's nest. Readers preferring the plain style will object to poetic passages of elaborate, extended sentences, one over a page long. Harding will disappoint those with little appetite for stream of consciousness narration and philosophical ruminations. They may sense a young novelist straining to express the ineffable, struggling to express that which defies language. Some readers might conclude that Harding may resemble Howard's father, a minister who went mad trying to explain the meaning of life.

Perhaps, but whatever its weaknesses, Harding's novel is an achievement. A virtuoso of style, Harding has a poet's gift for figurative language. He can evoke images of "splitting frozen wood so brittle that it rang when you split it" (23) and "the heartbreak of a cold sun" (24). He can describe wind "like a rumor, like the murmur of old men muttering" (59) and a hermit "attended by a small but avid swarm of flies "(38), choosing just the right details to change fiction into fact.

Alternating elegiac and celebratory, brooding and ecstatic registers, Tinkers becomes more than an excellent work of fiction. Rather, Harding transforms his novel into a spiritual exploration. He attempts to achieve nothing less than unveiling the secrets of our existence. That he doesn't succeed is no surprise. It is the quality of his efforts that we admire.

Lois Green, with Laura Smith Porter, The Last Chapter, Peppertree Press, 2009. Reviewed by Harvey Fenigsohn (May 2010).

"On the day you were born, you cried and the world rejoiced. Live your life so that on the day you die, the world will cry and you will rejoice."—Native American proverb

In her recent memoir, The Last Chapter, Lois Green exemplifies the wisdom of the above proverb. When Green passes away from metastatic breast cancer, the world will indeed have reason to cry. All of us - family, friends, and community- will suffer a poignant loss. But we take comfort in knowing that, on the day of her death, this woman will have much to rejoice. She can celebrate a life in which public and private achievements triumphed over painful setbacks. When Lois Green dies, even as we mourn her passing, the world will rejoice for a life well lived.

In a conversational style, Green's frank autobiography reveals the contradictory sides of the author - her self-doubt and her self-confidence, her humility and her pride. Taking us back to predominantly Jewish West Hartford, Connecticut, in the 1930's, Green describes the miseries and joys of her early years. At age two, after her parent's divorce she lived with a callous, critical mother at the home of a generous but mentally unstable grandmother. Green never forgot her mother's question to her fiancé when they were first introduced: "How could you have fallen in love with her? She's so fat." (p. 40). Such insensitivity led to Green's lingering sense of inferiority, but also inspired her to prove herself worthy – a fierce, life-long ambition.

Fortunately for the impressionable young girl, the warmth of her siblings, aunt, and a nurturing maid compensated for her mother's strictures and disapproval. Happy summers at the family beach house and the joy of reading relieved her unhappy home life. Many years later, Green forgave her mother, and reconciling with her, the daughter came to understand how her mother's emotional problems inhibited her ability to love.

After acceptance at a private boarding school for girls, Green put Hartford behind her, the memories of her early youth bitter-sweet. At Drew Seminary for Young Women, she delighted in the approval unavailable at home. Making close friends, Green excelled academically, delivering the valedictory address. She continued to flourish at Bryn Mawr College, graduating in 1952. Green could finally say "I was somebody. That fat little girl deep inside me developed a sense of self-worth, a conviction that I had value. In combination, prep school and college made me realize that I could do whatever I wanted. The opposite simply never occurred to me" (40).

Typical of many educated women of her era, Green married almost immediately after college, moving to her new husband's city of Worcester, Massachusetts, to become a "housewife." Green took seriously her responsibilities as a wife, and later as a mother or four children, but she wanted more. Unfulfilled, bored with her traditional role, she insisted on making the most of her talents beyond the home. Green gradually became deeply involved in a plethora of women's organizations and charitable groups, including non-profit service agencies and foundations, ultimately serving on boards, and as a trustee.

Green remained determined to challenge herself, whatever the obstacles, and in 1975, earned a Masters in Public Administration at age 45, despite her first diagnosis of cancer. Though Green never stopped volunteering, she established herself as a highly competent professional, taking on leadership positions, first at the Irving Glavin Center for Mental Retardation, and later as Executive Director of Elder Home Care and CEO of United Way of Central Massachusetts. Becoming vice chairman and then Chair of the Board of Memorial Hospital, she ultimately resigned after 18 years of service, crestfallen at being passed over for the Board chairmanship of the newly merged UMass Memorial Hospital, an experience that left a bitter taste for years. (139, 145)

Aware of Green's experience with geriatric and end-of life issues, , shortly after her resignation from the UMass Memorial Board, UMass Medical School offered her a position on the faculty as Director of the Geriatric Community Clerkship. Green has established a reputation for professional expertise and extraordinary social service, her contributions extending over half a century. In addition to the innumerable awards received for distinguished community service, including a Key to the City of Worcester, she was awarded honorary doctorates from Becker College (1999), University of Massachusetts Medical School (2003), and Clark University (2009). Nevertheless, despite validating herself in so many ways, Green confesses that she continues to feel "The fat little girl is still inside me" (157), revealing her lasting ambivalence toward success.

Concerned that her formidable outside commitments may have caused her to neglect her family, Green made extra efforts to meet their needs, aided by Bob Green, her especially supportive husband. With sorrow, she describes how her husband of nearly half a century died of cancer at age 76, the disease his wife battled for 36 years. She recalls too, with verve and humor, the sweet and joyous times the couple experienced with their offspring, and her rightful pride in their success.

For two reasons, Green titled her memoir aptly. For one, she admits that she always reads the last chapter of a book first. Green can't begin reading a book until she knows the ending, so great is her need for control. Secondly, given her incurable condition, Green's book is figuratively "the final chapter" in the book of her life. Nevertheless, as long as she remains alive, the truly "final chapter" of Lois Green's life has yet to be written. As she says, "I can't read it ahead of time. Perhaps I should be glad" (x).

Neither maudlin nor self-pitying, Lois Green lives on with a zest for life, a role model inspiring us to confront death with courage and dignity. Rather than yield to despair, Green confronts the stark immediacy of her extinction, comforted and relieved. Living on death row, she knows her sentence is irrevocable; there can be no stay of execution. Instead of feeling depressed because any day may be her last, Green remains uplifted and liberated - a woman at peace with herself. She is all the more grateful for every precious moment, reminding us that far too often we undervalue the treasure of time. In The Last Chapter, Lois Green reveals that it is never too late "to enjoy the here and the now," but only if we truly accept the brevity of life.

Tracy Kidder, Strength in What Remains: A Journey of Remembrance and Forgiveness, Random House, 2009. Reviewed by Harvey Fenigsohn (May 2010).

Location: Humanities in Medicine Collection
Call Number: WZ 100 N735 2009

Though nothing can bring back the hour
Of splendor in the grass, of glory in the flower;
We will grieve not, rather find
Strength in what remains behind;
In the primal sympathy
Which having been must ever be;
In the soothing thoughts that spring
Out of human suffering;
In the faith that looks through death,
In years that bring the philosophic mind.

—"Ode: Intimations of Immortality from Recollections of Early Childhood" William Wordsworth (epigraph to Strength in What Remains)

Borrowing the title of his book, Strength in What Remains, from Wordsworth's ode, Pulitzer Prize winning journalist Tracy Kidder shares the poet's vision - the belief that despite the inevitable loss of our childhood euphoria, as we mature, a modicum of resiliency always endures. With age comes suffering, but also the comfort of wisdom, enabling us to transcend grief over our losses even in the face of death.

In his non-fiction narrative, the author illustrates these beliefs with the story of Deogratias, a young medical student from the south central African nation of Burundi, a land roiled with the blood of Hutu and Tutsi tribesmen plunged into genocidal warfare. As Kidder reveals, Deogratias suffers shocking losses, including the near loss of his sanity. Nevertheless, escaping to America, he ultimately triumphs over an ordeal that might well have destroyed a lesser man.

In "Flight," the first half of the narrative, Kidder transports us to rural Burundi in the 1970's and the nearly idyllic boyhood of Deogratias whose loving family of herdsmen eked out harsh but satisfying lives in mountains and marshland both forbidding and beautiful. Kidder completely inhabits Deogratias' world. The author briefly speaks in the first person in "Burundi, June 2006," a short preface recalling his return with Deo to his native land, and again, when he describes first meeting the African in Boston in 2003. However, for most of the book, he employs the third person, absorbing himself into the psyche of his protagonist. In a series of flashbacks, Kidder tells the story almost entirely from Deogratias' point of view, though his empathetic reflections often reveal as much about the author as they do about his subject.

We come to understand the sensibilities of an ambitious, sensitive, spirited youth, one of very few village children bright enough to qualify for a scholarship to medical school. Surviving the ravages of malaria and the humiliations of mean-spirited teachers, Deogratias runs the gauntlet of a medical education, ignoring increasing political unrest and tribal tensions. But no one at that time and place in Africa could possibly avoid the rancorous power struggles and institutional racism left over from European colonialism. The Belgians, intent on grooming Tutsi managerial elite, earlier succeeded in exploiting and intensifying subtle ethnic differences between Hutus and Tutsis. Inevitably, in 1993, a Hutu uprising results in a murderous attack on the hospital where Deogratias interns. As a Tutsi, he must evade machete wielding killers, near starvation, and ferocious animals - a fugitive for six months. Aided by his own cunning and the surprising kindness of a stranger who risks her life to save him, Deogratias finally manages to outrun a holocaust.

Reeling from the horrors he witnessed, the callow young man boards an airplane for the first time, posing as a coffee merchant, his flight funded by friends, and with only two hundred dollars to his name, lands in New York City. Kidder convincingly conveys the bewilderment, loneliness, and alienation of a homeless immigrant. Speaking only French and having no contacts, Deo feels utterly bereft, once more having to prove his ability to survive. Again, a stranger (a French-speaker like himself) befriends Deo, offering him the squalid shelter of an abandoned Harlem tenement. But Deo aches for the open air freedom of his boyhood and chooses to sleep in Central Park, oblivious to the dangers. Despite all the dread he associates with Burundi, Deo still yearns for his African homeland.

His friend helps Deo find work as a grocery delivery boy, but his boss cruelly taunts the newcomer. Others prove more compassionate. A kindly religious woman tirelessly scours the city for decent lodging for Deo, securing him financial support and a warm home with Charlie and Nancy Wolf, a sociologist and his artist wife, who treat Deo like a son. Kidder reminds us that we human beings, the same species capable of centuries of genocidal butchery, can also fully extend ourselves with love to those we hardly know.

We realize as well how often our successes and failures depend on luck, but whether blessed by fortune or cursed by fate, how we react makes all the difference. Deo refuses himself the luxury of self-pity. Instead, he dedicates himself to mastering English, and after rigorous study, gains acceptance to Columbia University. In his philosophy courses, he sought to learn why human beings inflict the outrageous cruelties he experienced in Burundi. After graduating, Deo moves to Boston, becoming deeply involved in Partners in Health where he meets Dr. Paul Farmer, the subject of Mountains Upon Mountains, Kidder's widely admired account of Farmer and his life's work of defeating disease around the world.

Deogratias escaped Burundi but never eludes his memory of women obscenely violated, infants eviscerated, and whole villages obliterated. Continuously re-dreaming his nightmares, yet resisting psychological counseling, Deo compulsively recounts his story. Ironically, in Burundi the concept of gusimbura forbids recalling the names of the dead, emphasizing the need to forget the past, unlike in the western world, where we feel impelled to remember. But Deo cannot forget, nor can Kidder, nor can we, once we read his story. Though traumatized by unforgettable terrors, Deo finally returns to Burundi overcoming every bureaucratic and financial obstacle to build a village hospital serving Tutsi and Hutu alike. Indeed, Deogratias will "grieve not, rather find/Strength in what remains."

Enoch Callaway, M.D., Asylum: A Mid-Century Madhouse and Its Lessons about our Mentally Ill Today, Westport, CT: Praeger Publishers, 2007. Reviewed by Harvey Fenigsohn.

Location: Humanities in Medicine Collection
Call Number: WM 28 AM4 W923C 2007

Dr. Enoch Callaway, Emeritus Professor of Psychiatry at University of California, San Francisco, has written a memoir that is frank, witty, and humane. The author recalls his years from 1948 to 1950 as a resident in psychiatry at Worcester State Hospital, one of the nation's first state hospitals for the mentally ill. In a series of colorful vignettes, Callaway reflects on his personal experiences at this unique institution and evaluates the various treatments of the mentally ill from his time to the present.

Founded in 1833 as the State Lunatic Asylum in downtown Worcester, the hospital was renamed the Worcester State Hospital in 1877 when it moved to a larger building designed according to the progressive ideas of Thomas Kirkbride. Treatments changed over the years, but the nineteenth century structure of WSH remained nearly unchanged when Callaway arrived. (The original building downtown was renamed the Temporary Asylum for the Chronically Insane, and continued to be used even in Dr. Callaway's era.)

Callaway describes the impressive baroque architecture of the massive main building constructed of thick reddish stone, with an imposing clock tower and barred windows. He terms the place a "prison," but also a "fortress" protecting the patients from the outside world. A kind of self-contained city, the hospital included a 500-acre working farm providing therapeutic labor and food for over 2,000 patients, and 1,000 employees. However, only thirty of them were physicians.

The author recalls the warm camaraderie of his peers who literally were residents as most lived in hospital quarters. Living and working together 24 hours a day enabled them to exchange ideas and compare observations in ways hardly possible for today's residents. Callaway also shared his professional life with his wife, Dorothy, who lived with him in a hospital she initially experienced as threatening and repulsive. He expresses loving admiration for Dorothy as she comes to realize that most patients were more sick than harmful. We learn that the mentally ill suffer both the agony of their disorders and the pain of a society fearful of even the most harmless deviancy.

Callaway stresses the advantages of treating mental patients in a protected setting, but admits the limitations of mid-twentieth century psychiatry, noting that the few medications available at the time would now be considered "laughably inadequate" compared with the many powerful drugs of today (5). Lithium for bi-polar disorder, SSRIs for depression, Risperdal and Thorazine for schizophrenia, Buspar for anxiety - all were then unknown.

In Callaway's years at the hospital, schizophrenics endured a 90-minute coma as part of insulin shock therapy. Schizophrenia remains a baffling, debilitating disorder, but today's antipsychotic medications, replacing insulin shock, provide more hope to those afflicted with the disease's paranoia, grandiose delusions, and painful hallucinations. ECT (electroconvulsive therapy) is today a respectable therapy for profound depression, but Callaway makes clear that today's "civilized procedure" of ECT hardly resemble the crudely administered electric shock treatments of the past (28). A procedure he always considered "The Last Resort," lobotomy, now completely abolished, no longer permanently mars the mind and spirit of the victims of this brutal psychosurgery (31).

The author derides his generation's unquestioning enthusiasm for Freudian psychoanalysis, still a debatable methodology never wholly proven effective through empirical evidence. He describes his colleagues and himself "laboring with unbounded, and equally unfounded, faith in the psychoanalytic approach ... while ware-house-like rooms filled with deteriorated patients who defeated our best efforts" (6). His failures still haunt him, e.g., the schizophrenic teenager he failed to help despite her urgent pleas to "make the voices stop" (84).

Callaway remembers, too, his successes—some achieved by luck—including the remission of a seemingly damned schizophrenic whose disorder vanished when he accidently viewed his wildly disheveled self in a hand mirror. He recalls cases when patients clearly improved under his treatment, no longer requiring hospitalization, but concedes they may have improved on their own. He takes pride in the voluminous research done at the hospital, but also recalls that patients were not required to give informed consent.

At times, Callaway appears ambivalent. He describes Worcester State as "a model mental hospital circa 1950 ... a safe house where they [the patients] can recover" (6). However, regretting the many hopeless patients confined to grim back wards, he also characterizes the place as "a snake pit," the title of a film (1948) that grimly depicted life in a mental institution of that period (6).

Remembering inspiring role models, Callaway writes admiringly of Hudson Hoagland, founder of the Worcester Foundation for Experimental Biology, a prominent research center famous for developing the birth control pill. He recalls a visit from the distinguished psychoanalyst, Frieda Fromm-Reichmann, the model for the skilled psychiatrist in Joanne Greenberg's novel, I Never Promised You a Rose Garden (1964). He chuckles, remembering how Dr. Fromm-Reichmann's gentle, empathetic techniques proved so impressive that after her departure the residents unconsciously affected slight German accents. We come to understand that the practice of psychiatry is as much a healing art as a technical science.

Hospitalizing mental patients in an asylum may be viewed as a way of protecting society from the mentally ill. However, as Callaway notes, such hospitals also serve to protect vulnerable mental patients from the criminal justice system. Deploring today's tendency to reduce hospitalizations, Callaway regrets how frequently victims of serious mental illnesses end up in prison or in the streets—drug addicted, mired in squalor, viciously brutalized.

He looks back to a time when mental hospitals like Worcester State safely provided thousands of patients with compassionate care, and sadly reports that the hospital he knew became "a charred hulk" when a fire destroyed most of the original building in 1991(xvi). He can take heart that a new Worcester State Hospital, scheduled to be completed in 2012 at a cost of 302 million dollars, will serve some 260 adults and 60 adolescents.

Unfortunately, Callaway makes factual errors. Contrary to his claim, Worcester State Hospital was not the first state hospital in the country, nor was the Worcester Foundation for Experimental Biology ever moved from Shrewsbury to Worcester. The hospital famously satirized in Samuel Shem's The House of God was Beth Israel Hospital, not Massachusetts General Hospital. Callaway makes only passing references to Gerald N. Grob's The State and the Mentally Ill: A History of Worcester State Hospital, 1830 - 1920 (1966) and to Joseph Morrissey's The Enduring Asylum (1980), two good sources for the history of the hospital. Nevertheless, Asylum is valuable in vividly revealing the personal experiences of a resident in psychiatry and the state of institutional psychiatry in mid-twentieth century America.

Stephen J. Gould, Leonardo's Mountain of Clams and the Diet of Worms, New York: Three Rivers Press, 1998. Reviewed by Harvey Fenigsohn.

Location: Humanities in Medicine Collection
Call Number: QH 81 G698l 1999

"You may say, 'so what, we are surrounded by a plethora of items, and we can't know everything.' But I am insatiately greedy and infinitely curious ... we should rejoice mightily ... every new item can instruct us: every unexpected object possesses beauty for its own sake." (p. 195)

The above passage from the late Stephen J. Gould's eighth anthology of essays reveals his passion for fresh knowledge and delight in the multiplicities of nature. Originally appearing in the journal Natural History, the essays in Leonardo's Mountain of Clams and the Diet of Worms demonstrate Gould's fascination with the mysteries of the natural world. As a self-styled "humanistic naturalist" (p. 5), he sought to explore "the history of how humans have learned to study and understand nature" (p. 5). In doing so, Gould linked questions in paleontology, geology, zoology, and botany to the humanistic disciplines of biography, history, art, and religion.

A celebrated but sometimes controversial paleontologist and evolutionary biologist, Gould wrote numerous essays for a popular audience as well as scholarly articles. He refused to patronize his popular audience by simplifying challenging concepts, assuming his readers' wide breadth and depth of knowledge in science and the liberal arts. Awarded numerous honors, Gould gained special recognition for two books: The Panda's Thumb and The Mismeasure of Man.

This anthology contains twenty-one of his two hundred essays. Selected as one of "The Best Science and Technology Books of 1998," it confirms Gould's mastery of evolutionary biology and his appreciation of many other fields of knowledge. Never pedantic or ponderous, he imparts considerable scientific and historical facts in a graceful style infused with wit, humor, and irony. Literary allusions to the classics, Shakespeare, and the Bible provide universal relevance, while a thorough index helps reader locate subjects worth reconsidering.

Some readers find Gould's concentration on details distracting and tedious. He has himself admitted that though he uses details primarily to support his general ideas, he sometimes writes about details at length merely because he finds them so intriguing. Nevertheless, the patient reader discovers that despite the writer's apparent digressions, he invariably returns to his central thesis.

Gould's varied subjects include famous historical figures: Columbus, Boyle, Huxley, and the more obscure who nevertheless made significant contributions to human knowledge. Fascinated with the oddities of nature, he traces the evolutionary history of the dodo, defending the reputation of the much-maligned bird in "The Dodo and the Caucus Race." In another essay, he awards the denigrated sloth an honorable place in natural history, by demonstrating how this creature's slothful ways helped prevent its extinction.

In "The Upwardly Mobile Fossil," alluding to the anthology's title, Gould explains Leonardo's discovery of why and how marine fossils appeared in the strata of high mountains. In "The Clam Stripped Bare," he described Linnaeus's startling comparison of a clam's shape to the genitalia of the human female. Going beyond natural history, Gould sensitively reflected on human history, especially our capacity for mayhem. Savoring the double meaning of the term, "Diet of Worms," also part of the anthology's title, he despaired of the bloody struggles of Catholics and Protestants following Martin Luther's defiance of the Diet (the governing body) of the Holy Roman Empire in the German city of Worms.

The author often challenged conventional ideas such as the assumption that "old" equals "primitive." In "A Lesson from the Old Masters," he marvels at the elegant cave paintings of the anonymous Paleolithic artists whose realistic drawings provide our only reliable knowledge of the visual appearance of extinct mammals. In "Our Universal Unity," he debunks "one of the most common fallacies in human reasoning-the elevation to universal status of a local, limited, and potentially false belief held by an individual or culture" (p. 198). As an example, he derides "the assumption that human history should progress in a linear sequence of improvement (with Africans behind Europeans)," a fallacy he argued "may be the most harmful and widespread of all culturally embedded errors falsely promoted to universal truth" (p. 198).

Although his life was cut short at only sixty, Gould left behind groundbreaking ideas based on studies of the land snails, Poeciloznite and Cerion. In addition to his popular writing, he was best known for the controversial theory of punctuated equilibrium. Challenging the traditional belief that species change occurs gradually over time, Gould concluded that species undergo long periods of relative stasis until sudden changes (punctuations) occur in which they branch off with altered genes. In the anthology, he also challenged the long held notion that evolution implies change in a linear fashion, and ultimately leads to improvements in life forms, humans included.

Gould insisted that no conflict need exist between science and religion, coining the term "Non-Overlapping Magisteria." To Gould, science deals with facts, theories, and discoveries about the material world while religion considers moral meaning and spiritual values, an entirely different realm. Considering himself "a Jewish agnostic" (p. 270), he acknowledged that religion offers the comfort of belief in the sacred. However, Gould tended to side with Darwin, doubting the existence of "a beneficent and omnipotent God" (p. 297).

Nevertheless, he clearly expressed his deeply felt reverence for the splendor of nature and the inherent worth of all living things. Stressing that we are not merely biologically determined, Gould never lost faith in humanity. He emphasized our ability to act with compassion and nobility, despite ample evidence to the contrary. As Gould said in concluding his essay on The Diet of Worms:

The Cathedral of Canterbury is both the site of Becket's murder and the finest Gothic building in England. Both sides of this dichotomy represent our common, evolved humanity; which ultimately shall we choose? As for the potential path of genocide and destruction, let us take this stand. It need not be. We can do otherwise (p. 265).

Joan Didion, The Year of Magical Thinking, New York: Alfred A. Knopf, 2005. Reviewed by Harvey Fenigsohn.

Location: Humanities in Medicine Collection
Call Number: WA 308 D556y 2005

"Life changes fast. Life changes in the instant. You sit down to dinner and life as you know it ends." Thus, Joan Didion begins The Year of Magical Thinking (2005), her brilliant account of the year she spent denying the truth of her opening statement. In her grief over the death of her husband, John Gregory Dunne, Didion clung to the delusion that he would return to her. Though the author witnesses his death by a massive heart attack on December 30, 2003, she later refused to give away her husband's shoes; after all, he would need them when he returns. In Joan Didion's "year of magical thinking," as William Faulkner said, "The past is not dead. It's not even past."

An acclaimed prose stylist and winner of the National Book Award for her memoir, Didion describes an unusually close marriage of two writers living and working every day under the same roof for forty years. She and Dunne each wrote novels and essays, but also frequently collaborated on screenplays, seamlessly merging their personal and professional lives. In chronicling her reaction to the death of her husband, Didion honors his memory, leaves a lasting tribute to their love, and contributes a masterwork to the literature of grief.

Upon first learning of Dunne's death, Didion was characterized by a hospital worker as "a cool customer," but she remembers herself in a state of shock - stunned and frozen. Ironically, her adult daughter, Quintana, was also confronting death that night. Quintana had already been hospitalized and, now comatose, she developed pneumonia and septic shock. Didion must struggle with both calamities. In caring for her daughter and planning her husband's funeral, Didion used the pretext that she was far too preoccupied to acknowledge Dunne's passing—much less mourn the loss. Her self-deception had begun.

Unable to accept her beloved's death, Didion was locked in denial, denying not only her husband's demise, but also her own grief. Her flat unemotional language, all the more powerful for its restrained understatement, perfectly reflects her repressed state of mind. Didion is very much a contained writer who knows that less is better. She wields a razor-sharp knife to pare down her prose until only the essential meaning remains. However, while control in a writer is effective, control in a mourner is not. Holding back sorrow, Didion deprived herself of the relief only acceptance can bring. Her heart was broken, yet she refused to bleed.

Instead, stoical and impassive, she masked her suffering, deceiving both the world and herself. Didion admits that during that time she temporarily lost her sanity. Running from her anguish, she hid in the fantasy of a never changing past, safe in the day dream of her life with Dunne. The couple's quarrels and reconciliations; their Malibu home; their excursions to Paris, Hawaii, and Indonesia; their stylish restaurants and famous friends – theirs was a rarefied life of privilege. Like Didion, many of the writer's friends distinguished themselves in literature and film. She once thought such highly successful, powerful people could "control events." Only later did she concede that neither her friends' prestige, nor her own, can forestall our mutual fate.

As a consummate reporter and writer, Didion sought the cold facts. Researching the pathology of her daughter and husband, she steeped herself in medical literature, mastering the technical terms of the physicians, once even appearing at the hospital in scrubs. She insisted that her husband undergo an autopsy and learned every clinical detail of Dunne's coronary. But despite all the contrary evidence, she could not allow herself to accept the coldest fact of all: no medical treatment known to science will ever restore her husband.

Didion delves into what psychiatrists have concluded about grief, finding their pronouncements artificial, pedantic, and insensitive. She mocks the doctor who speaks of "the patient's need to keep the loved one alive," not recognizing how these words describe her own state of mind. Oddly enough for one with Didion's sophisticated sensibility, she finds "matter-of-fact wisdom" in the common-sense advice offered by Emily Post in her 1922 book of etiquette. Didion points out that "Mrs. Post … wrote in a world in which mourning was still recognized, allowed, and not hidden from view."

Though Didion tries, her pain cannot be numbed. She stopped eating, but not writing, and in her journal she addressed her wounded spirit. From that inchoate record, Didion crafted a memoir, fresh with raw feelings. Ignoring the assault on her psyche, Didion rejected self-pity, noting that outpourings of grief are today often perceived as weak and cowardly. It took a year for her to understand that the truly courageous can permit themselves to nakedly suffer and openly admit their pain.

Psychiatrist Elizabeth Kübler-Ross notably concluded that the bereaved typically undergo a sequence of phases, proceeding from denial to acceptance. But anyone who has experienced the death of a loved one knows the struggle with loss is neither straight-forward nor predictable. For Didion, denial became her only way to mourn. Near the end of the memoir she tells us, "I know why we try to keep the dead alive: we try to keep them alive in order to keep them with us. I also know that if we are to live ourselves there comes a point at which we must relinquish the dead, let them go, keep them dead." Joan Didion's year of "magical thinking" had ended.

Richard M. Berlin, Poets on Prozac, The Johns Hopkins University Press, 2008. Reviewed by Harvey Fenigsohn.

Location: Humanities in Medicine Collection
Call Number: WM 402 P743 2008

The famous Welch poet, Dylan Thomas, once described the condition of being a poet as "walking over broken glass with your eyeballs" (p. 13), as quoted in Poets on Prozac. Subtitled "Mental Illness, Treatment, and the Creative Process," this anthology of personal essays by sixteen poets was edited by Richard M. Berlin, MD, prize winning poet and Associate Professor of Psychiatry at the University of Massachusetts Medical School. In experiencing mental illness, each poet in the anthology suffered to some degree the lacerating psychic pain described by Dylan Thomas.

According to the editor's criteria, the essayists in Poets on Prozac had to be distinguished poets who published in literary journals, published at least one book of poetry, and undergone psychiatric treatment. Besides manic depression, the poets in the anthology suffered a variety of mental disorders including schizophrenia, obsessive compulsive disorder, post partum psychosis, and post-traumatic stress disorder. In collecting personal accounts from these poets, Berlin was interested in the influence of that treatment on their creative process. He attempted to discover how their poetry changed after the treatment and their reactions to the experience.

The editor's comprehensive introductory chapter traces cultural attitudes, and citing neurological studies, Berlin explores both historical and modern views linking creativity (particularly the writing of poetry) and mental instability. He reminds us of Shakespeare's famous line, "The lunatic, the lover, and the poet are of one imagination all compacted," and that, according to Robert Burton, "All poets are mad" (p. 2). In modern times, the connection of depressed poets and suicide has been termed "the Sylvia Plath effect," named for the gifted poet who committed suicide at age thirty-one. Berlin cites psychiatric research confirming that depressed poets, out of proportion to their numbers, attempted or successfully committed suicide.

Berlin notes that a whole generation of 20th century poets including Plath, Thomas, Anne Sexton, and Robert Lowell experienced serious mental illness. Many engaged in substance abuse and endured their anguish with little or no effective psychiatric counseling or medication. Often, poets' attitudes toward psychiatric treatment have been negative. When the renowned poet William Carlos William, underwent psychoanalysis, he said, "I might as well be experiencing treatment by a frog" (p. 3). However, as treatments have improved, all the contemporary poets in the anthology found some relief in a combination of psychological counseling and psychopharmacology.

Creative artists have feared, and some continue to fear, that psychiatric treatment will inhibit their creativity, flatten their perceptions, and alter their personalities. Wary of her medication, poet and teacher Jesse Millner worried that "I'd lose my writing voice, that the poems wouldn't come, that I'd be somehow numb inside" (p. 67). Berlin explains there is even a romantic notion that mental instability is necessarily an essential characteristic of artists. He quotes the illustrious German poet, Rainer Maria Rilke: "If I lose my demons, I will lose my angels as well" (p. 4).

Nevertheless, Berlin argues that empirical evidence suggests creativity results more from perspiration than inspiration. The writing of poetry most often requires a determined effort over time as poets laboriously craft their work, a process requiring calm reflection rather than wild fantasies. As internationally noted poet, Thomas Krampf said, "One can have a vision, but no vision is worth anything if one is too sick to implement it" (p. 39). Each of the sixteen writers told a different story but all their narratives revealed a common theme: personal satisfaction gained through creative achievement can mitigate the anguish of mental illness. The poet demonstrated estimable courage as they struggled sometimes patiently and often impatiently with the vagaries of psychopharmacology and the frustrations of counseling. Translator and dramatist Ren Powell recalled that she had seven therapists, "one of whom fell asleep during a session" (p. 51).

The poets had to endure the agony of broken relationships, humiliating setbacks, and debilitating self doubts in their struggle to maintain sanity. For example, Vanessa Hale, the victim of an abusive father, had to overcome OCD and post-traumatic stress before she became a tenured associate professor, later a psychotherapist, and a prizewinning poet. Fortunately, the poets' counselors and psychiatrists could instill healing self-awareness and prescribe the right combination of medications, enabling the poets to persevere, free of the symptoms of their diseases, even if the root causes may remain forever.

Far from romanticizing their sufferings, the essayists bitterly testified to the terror and shock of losing their minds, and most devastating to them, their ability to write poetry. As Gwyneth Lewis said, "After a serious bout of depression … I'd been unable to lift a pen, get out of bed, or speak for more than a minute of two" (p. 13). Nevertheless, she went on to become the first National Poet of Wales. It was most often their strong drive to reclaim their poetic voices that gave the poets the strength and resiliency, not to fully overcome, but at least to manage their debilitating illnesses. As Thomas Krampf acknowledged, "I would never claim to be entirely 'well' [but] looking back on it, I hope that the 'dark seed' of the experience of mental illness has borne fruit" (p. 39).

Frequently, the poets' subjects were themselves and their suffering. But, surprisingly, they rarely indulged in maudlin self-pity. Winner of a fellowship from the National Endowment for the Arts, J.D. Smith noted that, "Being a poet in despair does not necessarily make one a poet of despair" (p. 23). Nor did the poets use their disease to justify their sometimes self-destructive behavior. The writers came to realize that though they did not cause their disease, they, alone, bore the most responsibility for their own healing, not their psychiatrists, not their medications. They understood, too, that they could gain from their torment in better knowing themselves. As Lewis wrote in "Angel of Depression," "I'm broken, but my limp is the best part of me" (p. 13).

Though all the essays are infused with the striking, evocative language of poetry, some essayists succeeded better than others in revealing their stories and sharing their sense of self discovery. Perhaps the lingering trauma of the disorders tainted the writer's memory, inhibiting the poet from producing a narrative with a distinct beginning, middle, and end.

This lack of unity is not surprising, for none of the poets' stories are complete. Each will continue to bear ugly scars no psychic surgery can remove. Instead, they settled for a moratorium, using their hard won peace to earn respect from their peers and well deserved literary honors. In providing these poets with a voice in prose, Richard M. Berlin, himself both a healer and an artist, provides telling insights into both mental illness and the creative process.

Jean-Dominique Bauby, The Diving Bell and the Butterfly, Vintage Books, 1997. Reviewed by Harvey Fenigsohn.

Location: Book Collection (1st floor); Humanities in Medicine Collection
Call Number: WL 355 B337 1997

"Reflected in the glass, I saw the head of a man who seemed to have emerged from a vat of formaldehyde. His mouth was twisted, his nose damaged, his hair tousled, his gaze full of fear. One eye was sewn shut, the other goggled like the doomed eye of Cain." Jean-Dominique Bauby had never before described himself as such a wreck of a man. There was a time when Bauby seemed especially gifted with good fortune. Editor of Elle, a prominent French fashion magazine, he celebrated himself as a renowned journalist, urbane bon vivant, ardent friend, passionate lover, and dedicated father.

Tragically, Bauby's good fortune ended on December 8, 1995, when, at age 45, he suffered a massive stroke. Twenty days later, he awoke from a coma to find himself totally and permanently paralyzed. A victim of "locked-in" syndrome—absolutely immobile and completely speechless—he could communicate only by blinking his left eye. Trapped in the prison of own body, Jean-Dominique Bauby was now inert, an apparently helpless quadriplegic.

Nevertheless, Bauby remained alive, his vision limited, but his hearing unimpaired, and his mind lucid. That he still lived was no consolation. With mocking wit Bauby describes himself "reduced to the existence of a jellyfish." He mourned the loss of his glorified past, a life now forever spoiled. But self pity gradually turned to self discovery. Bauby came to understand that he might have been damned, but he was also blessed with a nearly eidetic memory and a limitless imagination. Instead of mocking him, Bauby's memories came to offer consolation and solace. Through his graphic imagination and vivid recall, he once more experienced many of the most gratifying moments of his former life -the piquant meals he had savored, the sensual women he had loved, the places and people he had cherished.

With all the audacity of the doomed, Bauby set about composing a memoir of both his real and his fantasy life in the hospital. After all, he couldn't speak, but he could at least blink one eye, and this he did, over 200,000 times. Bauby blinked in response to an amanuensis who recited the first letter in an alphabet beginning with the letters that occur most often in the French language (E, L, A, O, I, S, D …). A response of one blink signaled that, yes, she had come upon the first letter he needed to spell out the word he had in mind. Two blinks meant that, no, she had chosen a letter that wasn't the second letter of that word, and that she needed to try another letter. With admirable patience, his scribe continually repeated this tedious process, gradually helping him to spell one word and then another to finally form a sentence.

Through painstaking determination, Bauby ultimately spelled out enough sentences to complete The Diving Bell and the Butterfly, a best seller published just two days before his death in March, 1996. In 2007, the book was transformed into a highly acclaimed film directed by the American artist and filmmaker, Julian Schnabel. The "diving bell" of the title symbolizes Bauby's sense of himself as oppressively confined, alone, and underwater. The "butterfly" represents his ability to soar, liberated from despair by euphoric fantasies.

Bauby was confined for life, the hospital his jail house, but his was hardly a solitary confinement. Loyal friends visited, doing their best to sound out his blinking responses. Bauby's dedicated physical therapist, Brigitte, comforted him with facial massages, laboriously teaching him to move his head, if only slightly. Sandrine, his speech therapist, whom he named his "Guardian Angel," struggled to have him ultimately pronounce the whole alphabet, an exhausting triumph for each of them. After his ninety-two-year-old father telephoned his speechless son, Bauby poignantly remembered their previous meeting when he had given his father a shave, for he was once the caregiver. With his young children, Celeste and Theophile, Bauby could take pleasure in being wheeled down to the ocean shore where he imbibed the restorative salt air, admired the dancing sail boats, and viewed his offspring cavorting on the beach.

Despite his losses, Bauby treasured life to the end, demonstrating how pure resolve and a potent imagination can triumph over even the most seemingly hopeless of circumstances. That Bauby completed an entire book is itself admirable. But his achievement is even more remarkable in that the reader is made to hear the distinct voice of a mute man. In a tone alternately sarcastic and serious, plaintive and joyful, Bauby speaks to us. The memoir is a tour de force, a moving work of art, and an affirmation of the human spirit.

Perri Klass, MD. The Mystery of Breathing (Boston, Houghton Mifflin), 2004. Reviewed by Harvey Fenigsohn.

Location: Humanities in Medicine Collection
Call Number: PS 3561 K63m 2004

It has often been said that "Even a paranoid can have enemies." In fact, anyone under attack from an unknown enemy may succumb to paranoia. This is the painful discovery Dr. Perri Klass made when she became the subject of a venomous attempt to discredit her professional reputation and destroy her moral character. That the malicious assault was totally baseless came to mean very little, considering its traumatic effect on the victim. Nevertheless, in writing a novel based on her experience, The Mystery of Breathing, Dr. Klass ultimately triumphed over her unknown adversary. Her novel reveals that suffering the most disturbing of ordeals can have a positive outcome.

A graduate of Harvard Medical School, Dr. Perri Klass was a pediatric Intern at Children's Hospital in 1987 and a prize winning writer. At age 28, she had already written two books, one fiction, one non-fiction, and published stories in prestigious periodicals. A wife and a mother, as well as an ambitious author and a dedicated physician, she managed to balance family life with her strong commitments to medicine and to literature. The young doctor took justifiable pride in her increasing success as a writer and her acknowledged skills as a clinician. Talented and honored, she seemed to have her career very much on a fast track to eminence.

Thus, Perri Klass was hardly prepared for the near undoing of an apparently charmed life. Without warning and without provocation, an unknown adversary launched a scurrilous barrage of calumny against her. The assailant began with a sneak attack, sending accusatory letters to her publisher, to newspapers, and to doctors and nurses at Children's Hospital. The original documents from which she was alleged to have plagiarized were never produced, but putative copies mysteriously appeared, supposedly "original" material that closely resembled Dr. Klass's own writing.

Soon, letters and flyers appeared on the walls of the hospital and in the elevators, attacking Dr. Klass's competence as a physician, and alerting colleagues and parents to the lethal danger of having her treat children. The letters, often on the stationery of prominent hospitals and medical organizations, contained misspellings and inflammatory language. At one point, the doctor's anonymous enemy even hung pictures of her in the children's wards to warn parents to beware. Soon afterwards, unwrapping what appeared to be a beautifully wrapped present, Dr. Klass discovered a gift of human excrement. Clearly, she was being subjected to an assault by a deranged individual, quite possibly a dangerous one.

A full scale investigation ensued, involving a hospital detective and a lawyer. Though it was soon clear that the hateful attacks were totally without foundation, they clearly damaged Dr. Klass. She felt violated, much as the victim of a rape might feel, and at first, she wanted as few people as possible to know what was happening to her. She realized that some might give credence to the accusations, and even though she knew she was innocent, she began to question herself. Like many other interns, Dr. Klass realized that there were times when she felt herself to be a fake, given how aware she was of her inexperience and how unprepared she felt to make the life and death decisions required of every physician.

Dr. Klass consulted a psychiatrist who warned her not to respond publicly, for this would give her assailant the notoriety he or she desperately sought. But Perri Klass was, above all, a writer, one whose voice could not be silenced. The attacks resumed and Dr. Klass decided she had to write about them. Thus, she penned a brave piece in The New York Times and allowed herself to be interviewed by the press.

Finally, when the attacks ceased for good, Dr. Klass realized that her tribulations were not truly over, not unless she could bring herself to come to terms with the pain she had endured. There was more to say, but as she later explained, she was simply too close to the experience to describe her nightmare in a memoir. Instead, she chose to write a work of fiction using a third person narrator, distancing herself from the traumatic events but gaining the clear-eyed perspective necessary to help herself and others understand the meaning of her ordeal.

In Perri Klass's The Mystery of Breathing, the protagonist, Maggie Claymore and the author of the novel share intriguing similarities. Like Dr. Klass, Dr. Claymore was a dedicated pediatrician. As a neonatologist, she was totally devoted to her newborn patients. Like Perri Klass, author of A Not Entirely Benign Procedure, a book of personal essay somewhat critical of her medical education, Maggie Claymore was outspoken. Her frankness, and some might say, her arrogance, hardly endeared Dr. Claymore to her colleagues or to the hospital support staff.

Despite their similarities, Dr. Klass and Dr. Claymore differ in ways revealing that The Mystery of Breathing is clearly a novel, not a memoir. Klass came from an academic, literary, and liberal middle class Jewish family of high achievers. Claymore's background was more modest. Bright but poor, she was raised by a struggling single mother, a fervent Christian. Older than Klass, Claymore has no children and is exclusively focused on her medical specialty; the author's interests are more varied. Claymore, too, was cowed enough to keep a low profile, but Klass went public, regardless of the consequences.

We first meet Maggie Claymore as a practicing physician when she discovers that someone is out to smear her good name. For us to understand her character in depth, the author interspersed the initial story with brief chapters vividly recalling Maggie as a child growing up sensitive, lonely, and repressed. Like Perri Klass, Maggie was attracted to pure biological research, but both the author and her protagonist found themselves irresistibly drawn to medicine. The author convincingly describes life in a busy, big city hospital. With a sure hand, she sketches the setting of the ward with enough realistic details to establish verisimilitude but not so many as to slow the fast action of the narrative.

In telling the story of how a fictional doctor suffers an attempted character assassination, Perri Klass creates a suspenseful mystery, a kind of medical whodunit. As we come to know the various people in Maggie's world, we wonder exactly who might be pathologically motivated enough to perpetrate such a cruel and ruthless hoax. When Maggie is forced to confront her past, we learn that she has repressed incriminating secrets about herself. Though they are not known to her enemy, and are not publicly revealed, they are even more damaging to Maggie's sense of herself. Because, unlike the lies told by her adversary, these hidden facts were true. We learn that even the most apparently confident, seemingly assured person can harbor doubts under the intense pressure of rigorous self-scrutiny.

The novel reaches a crescendo when we finally learn the culprit's identity. We learn, too, how the experience of being persecuted has educated Maggie far beyond any knowledge she acquired in medical school. In this case, however, art did not fully imitate life. Perri Klass has harbored her suspicions, but her mysterious assailant was never discovered.

Of course, we can never know precisely to what degree Maggie Claymore was Perri Klass' alter ego. Both suffered the same vicious attempt to ruin them - professionally and personally. Similarly, though the author and her literary doppelganger may be scarred forever by their travail, each finally transcended her suffering and emerged stronger for it. Through The Mystery of Breathing, Perri Klass had the ultimate satisfaction of transforming her humiliation into a triumph through the power of art.

Body Language: Poems of the Medical Training Experience, ed. by Neeta Jain, Dagan Coppock, and Stephanie Brown Clark (Rochester, New York: BOA Editions, Ltd., 2006). Reviewed by Harvey Fenigsohn.

Location: Humanities in Medicine Collection
Call Number: WZ 330 B6687 2006

An ever increasing number of medical students and physicians also are talented poets. While they were students, Neeta Jain and Dagan Coppock, serious poets themselves, decided that outstanding poets from the medical world deserve a wider audience. Encouraged by their faculty advisor, Stephanie Brown Clark, they obtained grant money, found a publisher, and issued a nationwide call for submissions for an anthology. From the hundreds of poems they received, the editors chose ninety of the best for Body Language.

As the poets reflected on their rites of passage as medical students, writing served as a kind of therapy, helping them cope with the many physical, mental, and emotional challenges of their training. The anthology is organized by the chronology of their progress. We hear from students in their first and second years, consumed by rigorous academic demands, from students in their clinical years, troubled by difficult patients, from interns and residents, exhausted by endless hospital rounds, and from attending physicians, empowered but humbled by their new responsibilities.

In Section 1 of the book, first year students describe unforgettable moments when they move from the classroom to the morgue. Richard Berlin in "Anatomy Lab," faces his initial dissection: "That first day I sliced off her breast / scalpel circling round and round, the way I might halve a peach / to study her glistening secrets." In "Apparition," haunted by the harrowing image of his first autopsy, Greg Chesney fantasizes "I thought I saw my cadaver / sitting in the mall yesterday." The would-be physicians begin to understand they now live in a shocking new province, one where life is tenuous and death is a matter of fact. Second year student, Michael Jacobs, worries that his studies may keep him from what is most important: "I want to taste my life/before it melts away."

The compelling language of the poems draws us into the world of those who regularly witness unbearable pain. Far from feeling rigidly clinical, Kelly Jean White finds herself overwhelmed by her patient's incurable cancer. Touched by the tragedy, she seems to temporarily lose her professional identity. "Leaving his room, crying / avoiding classmates / I take the back stairs / I find myself locked, coatless / in the courtyard outside."

Students in their clinical years write of routine ordeals: endless hours in a surgery rotation, disturbing days with psychotic patients, and long nights in obstetrics. Yet they find time to craft remarkable poetry. Sometimes sarcastic and ironic, often serious and meditative, the poems always sound fresh and original. Along with the tools of their trade–stethoscopes and syringes–the poets use rhythmical cadences and striking imagery, a poet's tools.

Often the poems dwell on the same sad subjects: pain, despair, death; reading many of them at once can be depressing. Despite some relieving humor, there seems to be almost no end to the suffering and misery. Also, some readers may be put off by the graphic if not gory descriptions of surgical procedures. Nevertheless, the searing realism of the hospital scenes cannot be denied. Indeed, the poets hold nothing back. The defeats, the triumphs, the tedium, the drama: all are rendered through arresting metaphors and authentic details.

We wonder: would it not be better for doctors to distance themselves from their feelings, better to suppress emotions that only complicate treatment, better to coldly wield the scalpel? The poets of Body Language, however, insist on experiencing their medical training not simply as students and physicians, but as sensitive human beings. Realizing the need to be clinical and objective, they nevertheless struggle to maintain their compassion and empathy. They sense that to deny their feelings would be to deny their own humanity and that of those they serve.

Medical schools now understand the educational value of having students reflect on their learning experience through imaginative and narrative writing. Faculty also include literature in the curriculum, and respected journals publish the creative writing of students and physicians. Courses in the medical humanities have increased and some medical schools have added entire departments. At the University of Massachusetts Medical School, the Humanities in Medicine (HIM) committee, collaborating with the Library, developed a Humanities in Medicine collection, posted a HIM website, and regularly sponsors poetry readings by such noted poet/physicians as Rafael Campos and Richard Berlin. Last year the Library and HIM hosted the editors of Body Language, whose anthology is another sign that healers can themselves be healed by the power of the imagination.

The views and opinions expressed in these reviews are strictly those of the author. Comments and suggestions may be sent to Harvey Fenigsohn.