The White Tiger completes the trilogy of countries about which we have been given an insight through our book selections. China, Japan and now India. I previously only had the vaguest idea of what a flawed democracy was in fact the government of India. The creative vehicle of a letter to the Prime Minister of China from Baltram – humble servant driver and now entrepreneur worked very well. He was likable and seemed to be like a real person which made the circumstances he described and his actions seem very plausible. The book also clearly raised the question of whether democracy which allows corruption and basically slavery is any way a worthy form of government. Perhaps the reason that the author had chosen to have his character write to the Premier of China was because he wanted to raise the question of whether a democracy which permits such behavior as described in the book is better than a non democratic form of government such as that of China which through the governments efforts are raising the standard of living of it’s people in an organized manner. Of course in order to consider this book a reflection of the actual circumstances in India and events that while fictional, could have very well happened, as compared to a completely fanciful novel one would have to consider the credentials of the author. As stated in the book , he was born in India in 1974, attended Columbia and Oxford, was a correspondent for Time and currently lives in Mumbai India which seems to make him legit. Just the other day I cut out an article from the LA times titled “ Corruption scandal rocks India which had statements such as widespread and corrosive corruption …scandal with government official involving billions of dollars estimates that government lost 38 billion dollars equivalent of the defense budget or enough to feed 10% of it’s poorest populations for a year etc. This book also raised at least two moral questions- is murder ever justified especially when his victim was willing to sacrifice Baltram the killer when his wife ran over a child? The other questions which Balram never really deals with is how could he let his whole family be wiped out without even trying to warn them? There is also the Rooster Coop issue. How can one stand by and not escape or attack your captor when you see them one by one destroyed by the people who have locked you into this situation?
Archive for 2010
Buy now on Amazon: City of Thieves (Also available on Kindle!)
I read 90% of this book in one sitting on an airplane flying back to Los Angeles from China. So I obviously found it engrossing and it held my interest. Therefore I appreciate that it was recommended and made my flight easier. Having said that I do feel that if I am reading another heart wrenching story with painful graphic details of how innocent men women and children died as result of the Nazi’s during World War II, I would like it to have some new enlightening aspects of this history which will shed some fresh ideas on this atrocity, which I didn’t really find in this book Granted we did lean about horrible deaths often due to starvation and freezing temperatures as well as grisly murders for human food all due to the siege of Leningrad, in addition to the direct murder by the Nazis. While it is conceivable that some of the fanciful details how death was missed and survival occurred, may very well have happened to some people, our main characters seem to mostly have a string of good luck embodying an unusual amount of fortunate events. Perhaps the author was trying to have his cast represent many of the unusual, unbelievable and yet heroic things that the people of this beleaguered city had done. There also was a recurrent theme which seemed to be playing off the words and writings of various Russian writers, which might have been more interesting and coherent if I were familiar with these authors, which I am not. I did get the point that Koyla, the Russian deserter was whistling a happy tune because he was afraid himself and that his quoting the so called novel that his young friend never read, was actually from the novel which he hoped to write himself. However, all these references to Russian authors must have had some additional significance. Finally the author did something that I did not like. When Vika, the sharp shooting partisan decides to go her own way and depart from the the other two main characters, the narrator who is the young boy smitten with her ( who is supposed to be the authors grandfather telling him the story of his youth states, I knew I would never see her again. This is the author writing off this character which he basically restates in the next paragraph when he writes …and if the mystics are right and we are doomed to repeat our squalid lives ad infinitum, at least I will always return to that kiss. The character did not say I believed she was gone, he said I knew I would never see her again. Therefore when she reappears for the happy ending I was not only very surprised but I felt tricked with an unacceptable literary device. So in conclusion, while the book held my interest and will probably make a great movie, however for all of the above reasons, I give it thumbs down.
This book consists of 12 chapters which were written between 2006-and 2008 when Fallows and his wife were living first in Shanghai and then Beijing and were traveling through many other part of China. I read it just prior to our trip to China. Fallows was writing for the Atlantic Monthly and is considered by many people as the chronicler of life in contemporary China – at least to many American readers. Although he does not speak Chinese he works as a good reporter who has lots of friends and contacts and does seem to get close to the people. He also arranges interviews with interesting, some important and many typical people in various situations and locations. It becomes clear that China does not speak with one voice nor can it be easily characterized. The difference between life in the cities and life in the rural poverty stricken western part of the country is well described. The book clarified as best as one might, the complicated relationship between the Communist government on a national level and the local government officials as they impact life in this vast country. And vast it is . It is the size of the country and the 1.5 billion people that also makes this land and it’s people such an important force in the world. The freedom or lack of it to communicate in public or on the Internet, farming in the countryside, the growth of factories and manufacturing, how America out sources such to China, the failure and minor successes of trying to become green and deal with the environment, preparing for the 200 Olympics are some of the issues which this book explored. The author is very conscious of how Americans are trying to figure out China and whether to be fearful or embrace this country as we move into the 21st century. This book doesn’t fully answer the question but it is a good primer on this subject.
Vienna Triangle by Brenda Webster – Published by Wings Press, San Antonio, Texas, 2009
I originally wrote this book review for Academy Forum which is published by the American Academy of Psychoanalysis and Dynamic Psychiatry. I also subsequently published it in my blog PsychiatryTalk.com accompanied by a Q&A with the author which is also included here .
The year is 1968. Helene Deutsch is 84 and, while vacationing in Provincetown, Massachusetts, meets Kate, a young woman who, by coincidence, is writing her PhD thesis at Columbia University about the early women analysts. Dr. Deutsch is one of the most prominent, well-known and respected early women psychoanalysts and who had been in analysis with Sigmund Freud himself. One thing leads to another and in the course of their now mentoring relationship Kate uncovers some previously hidden documents belonging to her mother and which shed light on a family secret that her mother had withheld from her. This secret was that her maternal grandfather was the well-known psychoanalyst Victor Tausk who had been part of Freud’s inner circle and who had committed suicide.
Kate becomes obsessed with trying to unearth the details of her grandfather’s life and to find out why he killed himself. Dr. Deutsch who knew Dr. Tausk and even briefly analyzed him, reflects on distant memories and begins to bring forth pieces of the puzzle. These details involve Tausk, Freud and the beautiful Lou Andreas-Salome. Kate also stumbles upon information that leads her to meet her two previously unknown uncles, sons of the late Dr. Tausk.
Author Brenda Webster uses this plot in her novel to explore and describe life in Vienna and the complicated interactions both inside and outside of Freud’s Inner Circle during the birth of psychoanalysis. The personalities of the cast of characters unfold. Freud the creator, the father figure, is portrayed as extremely protective of his newly developed “baby.” Tausk is described as a brilliant young man who is making important contributions to psychoanalysis but who feels he is not quite appreciated by the Master. He develops a love affair with Salome who at the same time has become one of Freud’s favorite pupils. Young Helene Deutsch is making her own contributions about psychoanalytic theory and women at the same time that she is having her own love affairs. Freud does not grant Tausk’s request to be analyzed by him and instead refers him for analysis to Deutsch. There is a question about whether Freud’s harsh and rejecting treatment of Tausk contributed to his decision to take his life. Documents that purport to show Freud’s reaction to his junior colleague’s suicide do not paint a flattering picture of the leader of the psychoanalytic movement.
The characters in this book are interesting and well developed. There is love, romance, jealousy, rivalry, narcissism, loyalty, rejection, dedication to the cause, and the mysterious suicide of Tausk that contribute to making this a fine novel. It is a page-turner (or in my case a button pusher – I read books on the Kindle). This book should have strong appeal to all students of psychoanalytic and psychodynamic theory. It is well known that to fully grasp all of these ideas you need to go back to the streets of Vienna and the lives of the people who were bringing forth this revolutionary new understanding of human behavior.
However there may be a problem with this book. It is a novel. It is fiction. If you are thinking of reading it to understand the intricacies and nuances of the relationships that existed in Freud’s inner circle, shouldn’t you really be in the non-fiction aisle of your library, bookstore, or frame of mind (if you are buying online).
Brenda Webster states the following in her authors note at the beginning of the book: “This is a work of fiction, not of history; nevertheless it is based on the lives and relationships of real people: Viktor Tausk, Sigmund Freud, Lou Andreas-Salome and Helene Deutsch. I have attempted not to violate the known facts, but have invented diaries, dialogs and secondary characters in order to bring the actors, their ideas and passions to full imaginative life.” This is an ambivalent statement. She says that it does not violate the known facts and yet all sorts of things have been invented.
In the author’s afterword she further elaborates that an important letter mentioned in the book from Freud to Andreas-Salome after Tausk’s suicide is genuine, as are her responses to it. (This is one of the documents to which I referred to above.) Webster also cites Kurt Eissler’s writings that she says defended Freud’s treatment of Tausk. This suggests that she made efforts to found the main premise of the book on as much fact as possible.
My advice to potential readers is as follows: If you have been around the block and studied the history of psychoanalysis to the point where you are satisfied with what you know, or if you don’t really care about who said what or who was jealous of whom etc., then consider reading this enjoyable and interesting novel. It is fun thinking about these people even if many of the facts, attributions and nuances may not be correct. However, if you are a new student of psychoanalytic theory and want to learn more about these historical figures and how they interacted while coming forth with these ideas, hold off reading this novel. I suggest instead, that you read some of the many historical accounts, biographies and diaries, which are available about this period of time and these important people. Ask your teachers and mentors for suggestions, in particular about areas of your interest. By the time the movie comes around of this intriguing plot, if they ever decide to make one, you will be ready for this version of the story.
The following is a Q&A with the author Ms. Brenda Webster
MB: What attracted your interest to these characters and the birth of the psychoanalytic movement?
BW: I had written two previous books of psychoanalytic criticism and a memoir chronicling my history in therapy and had no intention of doing more. Then one day I was reading about how the great Goethe sucked the life out of people close to him and used them for his own purposes. This made me think of Freud and Viktor Tausk. I wondered if genius couldn’t tolerate the existence of great talent in its vicinity and I was off and running.
MB: On one hand you emphasize in the author’s notes at the beginning of the book, that this is a work of fiction, not history, but on the other hand you note that you have attempted not to violate the known facts. Is the story your best guess as to what was the nature of the relationships which you wrote about or is it rather an attempt to write a fanciful interesting novel ?
BW: As I researched my story—and I read everything I could get my hands on from background material to biographies of Deutsch, Lou Salome, Tausk and Freud—I came to feel that Freud played an important role in Tausk’s suicide.and subsequent cover up. I had no impulse to write a polemical book. (My analyst Kurt Eissler had written two books defending Freud) I wanted to explore what happened, to re-create the people and the situations to decide for myself what motivated them. Fiction was from the beginning a way of gaining imaginative insight.
MB: In the story, you show Freud as using Tausk’s ideas without crediting him . As a writer yourself, do you view this as a particularly immoral act or do you believe that things like this can happen without malicious intent?
BW: I think that writers often borrow from each other but in the case of Freud and Tausk there was so much emotional freight behind the borrowing. Each man accusing the other of not giving credit that it took on a more sinister coloring.
MB: Can you picture this book as a movie and would you like to share your ideas as to which actors and actresses might best capture the spirit of your story ?
BW: Yes, I can picture it as a movie. The first thing the Freud scholar Paul Roazen said when he read my early draft was that it would make a terrific movie. I don’t keep up with contemporary actors but I think someone like Helen Bonam Carter would be good for Lou. Both sexy and super intellectual.
MB: Where will you be taking your readers in your next book?
BW: I am working on a play with a New York Producer/director that carries on my interest in Freud and his circle. So far it has been an exciting experience
A Journey Between China’s Past and Present. Oracle Bones
491 pp. HarperCollins Publishers. $26.95. (2006)
Peter Hessler is an American who joined the Peace Corps and was assigned to China in 1996. After his rotation there is decided to live in China for awhile and took a position teaching English. He has mastered the Chinese language himself and was able to speak quite well. He developed good relationships with his students and he continued to communicate with them over the next several years, often visiting them as they made their way exploring various jobs and careers. Hessler then began to travel around China himself working as a free lance journalist and eventually taking a position as the Beijing correspondent of New Yorker magazine . This book covers a time period of of 1999 to 2002. I read this book in 2010 just prior to visiting China. I get the impression from this book and others that I have recently read , that China is in such rapid transition that some of the depictions even in this book must be viewed as historical .
The title of this book comes from the fact that the earliest Chinese writings were on the shells and bones of ancient tortoises. Hesler does focus on archeology for much of the book as the story of China does seem to be that of a vast country which has been searching to understand it’s complicated history and to understand where it has fit Into the scheme of the world in the past and what will the role of China be in the future. The migration pattern within the country in the past as well as in the present as illustrated by the lives of his young students with whom he tries to keep track. Their stories and the stories of their families are ones of seeking opportunity escape from poverty It should be clear to people who understand China and it certainly emerges from this book, that there are quite diverse ethnic groups in China. Hessler’s friendship with Polat a Uighur from what was East Turkestan is one such illustration. Polat’s success as a currency trader especially with the Russians is very interesting as is his decision to do a little deception ( as everyone seems to do ) and arrange to move to the United States.
American readers such as this reviewer have been interested in trying to understand the Chinese political system which on one hand encourages private business but is an repressive dictatorial regime at least some of the time. Some of the times are illustrated what happened in Tiammenan Square and what happens periodically when various dissident groups try to demonstrate or speak out against the government. One case in point is the life and death of Chen Mangjia, apparently a brilliant archeologist who end up killing himself. Hessler becomes very interested in understanding this man and what happened to him. While he never quite figures everything out, his quest to understand Mangjia’s life leads to him to meet and speak with many people . His writing about this man is revealing about China. For example Mangjia apparently thought that China should stick with it’s traditional writing characters at a time that the government was considering a change to a more western style of writing ( which was never instituted ). Nevertheless, Mangjia was labeled a “rightest” by the government and was actually sent away for several years to be “educated“ He may not have been the same again and apparently committed suicide.
The book ends prior to the 2008 Olympics which ended up being held in Beijing. The efforts of the country to get the Olympics to China were monumental as was the preparation for it. This book touches on the journey that China underwent and the potential impact expected form having the games.
I wish that I had thought to have a map of China handy as I read this book. Unless you are fairly familiar with the geography of this gigantic country and know where the various cities and regions are located, it can be a little confusing . Howeve this should be easy to remedy with a good map nearby.
Peter Hellser has made it very easy to share the several years of his life which he devoted to exploring and trying to understand China..The process of doing this allows the reader to begin to appreciate this vast dynamic land.
When Family Are Oceans Apart
Patients in psychotherapy spend a great deal of time talking about family relationships. We examine the nature of the early childhood memories and interactions with parents, siblings and grandparents as well as other close relatives For most people, these relationships are usually the templates for the development of our personality and the strengths and weaknesses of our character formation. Obviously, sometimes there are problems and conflicts, which make us stronger and teach us how to deal with difficult situations. On the other hand, they may lead to symptoms and serious difficulties which will benefit from some form of therapy, usually later in life. . As we get older we can appreciate how important our presence can be to children to whom we are close.. Many of us also come to value ongoing relationships with our children, parents, siblings, grandparents and other close relatives.
But what happens when life circumstances separate us from important people in our lives? In today’s world most people can’t expect to spend their lives in close proximity to their immediate family. While something may be gained by being more independent, something is also lost by drifting apart from people whom you value especially when there are children involved.
A New Book for Family Members When Someone Has Moved Away
This is why I was so interested to see a new book titled Oceans Apart: A Guide to Maintaining Family ties at a Distance by Rochel U. Berman published this year by Ktav Publishing House of Jersey City. Ms. Berman is a M.S.W. social worker currently living in Florida with her husband. She also is a personal friend of mine. In order to write this book she not only has drawn upon her professional experience which includes conducting an extensive number of interviews with various people in 25 different countries , but has drawn upon her own life experience as her son and his family have lived in Israel for the past 20 years.
In her opening chapter she lists five reasons that people move away.
1- Looking for a better life
2- Forced migration
3- Education and career opportunities
4- Changes in marital status
5- Pursuing and ideology
Even those among us who did not need to pursue a better life or migrate to another country, probably know of how that was a major factor in the lives of a close relative in their family in the last one or two generations. With the ease in which we can travel and meet people, it is no longer invariable that people will find their spouse within walking distance of their own home. Going to college, graduate training, medical residency, job recruitment almost always include “ going out of town “ which may lead to permanent livng arrangement away from family. While not mentioned it certainly also applies to members of the military may have to relocate, hopefully with their spouse and children but when deployed they may be separated for a year or two under the most trying circumstances.
The author discussed the reason for moving away by giving specific case vignettes, a technique she uses throughout the book which brings it alive as well as making it very practical. She also concludes each chapter with a section called “ Lessons from Life “ applied to the specific chapter where there are usually ten or more specific suggestions or valuable advice. The ideas in the first chapter alone , I thought qualified as valuable pearls of wisdom. For example there was the suggestions to create photo albums of distant grandparents, uncles, aunts and cousins which should be looked at to reminisce or prior to visits. There also was valuable tried and true techniques for parents to use in dealing with children of divorce.
Living Far Away Doesn’t Mean that You Can’t Be Close
The second chapter was titled Keeping In Touch: Problems and Opportunities, could best be summarized by the opening quote of that chapter “There are many families who live next door to each other who don’t have the relationship we do Mom, we will always be close despite the distance” – A son to his mother following her yearly visit
This was followed by the chapter which probably will be the main reason why people will give this book as a gift to loved ones and that is the chapter titled Grandparenting at a Distance.. The six very practical areas covered are:
1- Staying connected between visits
2- Telephone and other means of communication
3- Preplanning visits with grandchildren
4- Grandchildren visiting alone
5- As grandparents age
6- The effect of distance on relationships.
Each of these topics are elaborated upon through the sue of wonderful vignettes
These are not psychoanalytic case studies although the psychodynamic meaning is usually close to the surface and the practical lesson to be gained is always very clear.
Getting Through The Rough Times
In a subsequent chapter Ms. Berman writes about Getting Through The Rough Times which deals with how to deal with illness and death. This is a subject that she is quite knowledgable and sensitive. She is the author of an earlier very well received book titled, Dignity Beyound Death. Her advice includes suggestions on establishing your own relationship with doctors and caregivers even when you are far away, planning to have final conversations with your terminally ill loved ones and carving out a role with siblings in the care of loved ones.
Sibling Relationships Can Be The Most Difficult
On the bases of my clinical experience, it is frequently the rupture of relationship with siblings which can be the most painful and difficult to heal. I am speaking of situations where the parties are not even separated by a great distance. Therefore it is interesting to see how the author addressed techniques for maintaining ties with distant sisters and brothers as well as distant nieces, nephews and cousins. I believe that many of the lessons from life in these areas could also well be applied to relationships, which are not oceans apart. Interesting also is the discussion about the importance of family traditions and rituals as well as how to share celebrations even when separated and how to deal with missed celebrations. This includes this issue of the cultural divide and discussion of relating to family members who now have different traditions than the ones with which they grew up. Once again, there is great application for these ideas even to people who live in close proximity.
Creative Use Of Technology
I loved the last chapter which was written by the author’s husband George Berman and that is the one titled , Creative Uses of Technology . He clearly is an expert in communication and is comfortable in many modes which of course not only includes the telephone but Internet Video, Instant Messaging and family Websites and blogs. Obviously a chapter such as this one becomes outdated the day that it is written due to constant innovations in social media.
However, the message of this book is definitely current and is becoming more pertinent every year as we become a global society. It should be a great psychological tool for the mental health of those who in one way or the other are oceans apart.
Take Five With the Author
Dr. Blumenfield asks Ms. Berman 5 Questions
TAKE FIVE WITH THE AUTHOR
Why did you decide to write the book?
For the past 20 years I have struggled to maintain family ties with my son, daughter-in-law and four grandchildren who live in Israel. This led me to research the network of distant family relationships with 70 people from 25 different countries. Oceans Apart tells their stories and describes the courageous and creative responses to the challenges they face.
Are you concerned that the application of some of the suggestions made in the book might be considered as being too intrusive to the distant family?
It’s true that some people move far away because they want to get away from family so that they can develop their own lives. This, however, wears thin after a while, and most of them wish, at some point, to reconnect with their roots. I believe that in order to develop meaningful and lasting relationships at a distance, one must be proactive, plan ahead and be specific in terms of goals and objectives.
Do you feel that anything has been lost since people rarely sit down to write long letters anymore and instead rely on more instant communication?
Email and text messages tend to convey only information. What’s missing from them, that is embedded in a long letter, is the contemplative and reflective aspects of what’s going on in one’s life. While this can be done via email, unfortunately, we rarely take the time to do it.
If it is only practical to make one visit to a bereaved far away family member, would a more leisurely visit several weeks after the death be better than a short condolence visit immediately after the death or attending the funeral?
There are several issues that need to be considered, namely the needs and expectations of the bereaved, your needs as well as family and/or religious customs. This is something that should be discussed with the bereaved family at the time of death or in advance if it appears that death is immanent.
You have written very effectively about death and separation. What is going to be your next project?
I am coordinating a half-day seminar on “Families at a Distance” that my synagogue is sponsoring for the entire community including people of all denominations and faiths. The centerpiece of the seminar will be five concurrent workshops led by mental health professions. The purpose of this innovative endeavor is three-fold: To ensure participants that they are not alone in their struggles; to share information; and to seek solutions that they will implement going forward.
Prior to reading this book, I had recently read Shanghai Girls by Lisa See which is about two Chinese sisters and chronicles their lives from the horror of the Japanese invasion in China to the painful unfair discrimination which they encountered in this country during and after World War II. Hotel on the Corner of Bitter and Sweet which is debut novel by Jamie Ford in a sense compliments the other book as it provides insight into the fate of the Japanese living in the United States approximately during this time period. Most Americans, of course know very little about this page of our history. This novel provides a window into what happened when the Japanese families were ripped from their homes and jobs and put in what were called internment camps by the government but prison camps by the people who were involuntarily taken there. While the story was quite poignant and sweet, it did not have the complexity of story and the depth of characters, which I thought was present in Lisa See’s book.
The story is mostly told through, through the eyes of Henry, a Chinese American who was born in the United States to immigrant parents who expected him to speak English although they could not and maintain their Chinese heritage which included a hatred of the Japanese who had attacked their native country. As a youngster he was sent to an upper class white school in Seattle on a scholarship, which meant that he had to help out in the kitchen at lunchtime and clean the erasers after school. While doing this job he meets Keiko, a Japanese girl, also born in the US and sent to this school by her proud parents. They work together, become good friend and even develop an emotional bond which becomes disrupted when she, her family and her entire Japanese community is whisked away almost overnight. The attempt of these barely teenagers to hold on to each other in these impossible circumstances is quite touching. The Hotel Panama is one of the last remnants of the Japanese community and had bordered on the still thriving Chinese community. It is the place where so many of the artifacts of the now transported Japanese Americans have become eternally stored symbolizing their buried memories.
We don’t really get to know these characters of this book as fully formed multi-determined individuals. We are actually introduced to Henry at a point in life where his wife has died and his son is ready to get married. We know very little about him other than that he has this burning memory of his early love at age 12-13 which is locked in his soul. We learn about this phase of his life as chapters flashback to this time .
The mood of the book is unfulfilled forbidden love which perhaps symbolizes the unfavorable lives of the community of people where their most prized possessions reside in this Hotel of Bitter and Sweet also known as the Hotel Panama. The sadness of loss is also played out in the somewhat lengthy discussion of the Nursing Home death of Henry’s s childhood close friend Sheldon. When the movie of this book comes out , the musical score will be the soulful sound of legendary Seattle jazz musician Oscar Holden which was an important part of this story and played in the background for most of the telling of this tale.
Handbook of AIDS Psychiatry by Mary Ann Cohen, Harold W. Goforth, Joseph Z. Lux, Sharon M. Batista, Sami Khalife, Kelly L. Cozza and Jocelyn Soffer, Oxford University Press, New York, 2010, 384pp, $49.95
Book Review originally written for and published in the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry
It is unusual for the Book Review Editor of this journal to request a review about a book that does not have psychoanalytic theory, dynamic psychiatry or the application of these ideas, as it’s main thesis. This book, which is about all aspects of AIDS, is such an exception. It is fitting that it be presented to the readers of this journal since this disease, more than any other modern day medical condition has impacted all aspects of psychiatry and mental health. Those of us who were practicing in the early 1980s, especially if you were doing hospital consultations, first saw this become known as a mysterious disease with dark spots on skin that was universally fatal. It then became associated with homosexuals and drug addicts The disease was believed to be highly contagious and caused by blood and sexual transmission. Medical personal became fearful of contracting the disease from patients. An accidental needle stick while drawing blood or being nicked with a scalpel during surgery, which once was an inconvenience, now became a potentially fatal event. The disease weakened the immune system and could lead to deadly opportunistic infections. It ultimately was identified as being caused by the Human Immunodeficiency Virus (HIV). From it’s discovery in 1981 to 2006 AIDS killed more than 25 million people and is still counting.
Not only did psychiatrists and mental health professional see the impact of this disease in our hospital work but those of us doing outpatient psychotherapy could not help but appreciate the effect of this pandemic on many of our patients. Homophobias, which could be multidetermined at any point in time, became greatly exaggerated because of fears of contamination from AIDS. There was a reexamination of all sexual behavior as people began to realize that heterosexual transmission of this disease was also a reality. Questions were being raised whether couples should exchange HIV testing results before engaging in sexual relations? Then there was the realization that AIDS was devastating the gay and bisexual community. We saw a grieving response that extended beyond immediate close friend and families. People throughout the country visited exhibits of traveling AIDS quilts with patches made as a memorial to individual patients. There were forensic issues encountered by some of our colleagues where people were acting out their anger about being HIV positive by having unprotected sex . There were discussions among therapists of how to deal with a patient whom they knew was HIV positive but was not telling his or her partners.
The NIH and the NIMH awarded huge amounts of grant money directed towards AIDS and HIV research in the past 25-30 years. As a result many of the psychiatrists practicing today were supported by these grants at some time in their career or were trained by people who had such support and were well oriented about the psychiatric and psychological aspects of AIDS.
All of this is what makes this 2010 first edition of the Handbook of AIDS Psychiatry such a valuable book. Psychiatrist Mary Ann Cohen, a pioneer in the AIDS field and her six outstanding colleagues have written a book, which includes just about everything we should or might want to know about HIV and AIDS. It is billed as a practical book, which it is, but it is also a definitive work on this subject with over 1500 references. Some of the chapters are adapted from an earlier book titled Comprehensive Textbook of AIDS Psychiatry edited by Drs. Mary Ann Cohen and Jack Gorman, published in 2008 also by Oxford. Seven of the contributors to the earlier work took on the task of developing this current book.
This is not an edited book. All the 14 chapters are written by some combination of the seven authors. Dr. Cohen was involved in all but two of the chapters. Drs. Battista and Soffer were listed as residents at the time the book was published. The first 13 chapters were each followed by multiple pages of references and the final chapter on resources had addresses, phone numbers and web sites.
The widespread imprint of this disease and the comprehensive approach of this book is illustrated in the first chapter where the authors lay out the setting and models of AIDS psychiatric care. They start with effective parenting and prevention of early childhood trauma and conclude with the sections on education, HIV testing, condom distribution, rehabilitation centers, chronic care facilities and nursing homes. They touch upon the prejudice and discrimination labeled as AIDSism which unfortunately is ubiquitous and is also discussed in other chapters in the book.
Chapters titled Biopsychosocial Approach and HIV Through The Life Cycle cover material with which a psychiatrist trained in the past twenty-five years should be quite familiar. However the authors are not content with just reminding the reader to take a comprehensive history in areas relevant to this disease, but they offer over 100 suggested questions in doing a sexual history, suicide evaluation, substance abuse history or a violence evaluation. The following are examples of a few questions, which you may not have thought to use:
1. (Taking a sexual history) How do your cultural beliefs affect your sexuality?
2- Are you aware that petroleum-based lubricants (Vaseline and others) can cause leakage of condoms?
3- (To an LGBT person) What words do you prefer to describe your sexual identity?
4- (Evaluating suicidality) Do you plan to rejoin someone you lost?
5- (Taking a substance abuse history) What led to your first trying (the specific substance or substances)?
6- What effect did it have on the problem, crisis, or trauma in your life?
While it is stated that little is known about the relationship between aging and manifestations of psychiatric disorders in HIV positive persons, the discussion and questions raised about this topic in these chapters seem particularly important as treatment is now allowing people with AIDS to become senior citizens.
In the chapter titled Psychotherapeutic Treatment of Psychiatric Disorders it was noted that the enhanced understanding of the conflicts and struggles of the HIV positive patient afforded by psychodynamic psychotherapy has been described by multiple authors. This modality of treatment may be especially suited for patients with a trauma history as physical changes in the body and relationship stresses can awaken conflicts triggered by early trauma and neglect. This history of childhood emotional, physical and sexual trauma as well as neglect is also reported to be associated with risk behaviors and is prevalent in persons with HIV. Other major themes, which were identified, that could surface in psychodynamic work include fears about mortality with the erosion of defensive denial as the illness progresses and conflicts surrounding sexuality. There also was a review of interpersonal psychotherapy, CBT, spiritual focused care, and various group therapy formats.
The chapters on psychiatric aspects of stigma of HIV/ AIDS will also be of particular interest to the readers of this journal who are usually quite involved in dealing with subtle nuances in psychotherapy. Victim blaming, addict phobia and homophobia also called heterosexism are discussed in this context. While clinicians usually don’t have any trouble identifying stigma when they see it, there are scales which can be administered in both research protocols and clinical settings.
Dr. Cozza is the lead author in the chapter concerned with psychopharmacologic treatment issues. It is the longest chapter in the book and can best be summarized by their conclusion that the prescribing of psychotropic or any other class of medications to HIV positive patients taking ART is a complicated undertaking. The chapter provides an explanation of this statement in a narrative style as well as with some detailed tables showing the propensities of various medications to cause inhibition and induction.
Although psychiatrists are usually not involved with the treatment of physical symptoms or the actual administration of therapeutic drugs for medical conditions, if they work with patients with AIDS they will be discussing various symptoms and complications. Dr. Goforth and Cohen put together two chapters which clearly explain symptoms of AIDS, as well as the medical illnesses associated with them. They review fatigue, sleep disorders, appetite problems, nausea and vomiting with a complete differential diagnosis and intervention options. The full range of endocrine problems, dermatological disorders , HIV associated opthamalogical diseases, malignancies, liver and kidney disease as well as the potential symptoms of these conditions are covered.
The one chapter, which was written by four authors, was titled Palliative and Spiritual Care of Persons with HIV and AIDS. This not only covered a discussion of the management of pain, other physical symptoms, behavioral symptoms including violent behavior and suicidality but it offered a review of models for spiritual care. The work of Breitbart and colleagues with cancer patients using meaning centered interventions based on Victor Frankels ideas was introduced as was Kissane and colleagues description of a syndrome of “demoralization” in the terminally ill which is distinct from depression. It consists of a triad of hopelessness, loss of meaning and existential distress expressed as a desire for death. A treatment approach for this state is outlined. This chapter concludes with a review of the role of psychiatrists and other clinicians at the time of death and afterwards. This includes a discussion of anticipatory, acute and complicated grief.
Although HIV disease and AIDS is no longer the mysterious disease which people are afraid to talk about and healthcare workers dread seeing patients with, nevertheless it is a very serious illness which cuts across all specialties and has great relevance for psychiatrists and other mental health professionals. It is estimated that more than one million people are living with HIV in the USA. Even now with retroviral treatment available, this disease is expected to infect 90 million people in Africa resulting in a minimum of 18 million orphans. Needless to say, this book should be translated into many languages and should be available internationally. This book gives us a full background about AIDS and allows psychiatrists and other mental health professionals to have this fund of knowledge at our fingertips. Also, if and when there is another deadly virus that appears on the scene, our profession will have a model and a valuable compendium of how to approach it, which is something we did not have thirty years ago.
Summer’s Lease by John Mortimer, Penguin Books, 1988
If you want some good summer light reading, this book is for you, especially if you will be vacationing in Italy and renting a lovely villa. This is just what Molly Pargeter, the main character of this book did with her husband and her three girls.. Her father, a columnist for a British newspaper and a self proclaimed ladies man also came along. Not surprising, Molly found more than she expected, hence your summer mystery. Molly usually handled all the details of their summer rental and naturally has a great deal of curiosity about the owner of the villa and his family. She is also s dying to find out why did the owner specify that he wanted renters with three children, all girls. Then there is the strange occurrence of the water being unexplainably being drained out of their pool as well as of the pool of a neighbor’s pool. The difference being, in the later case the dead body of Mr. Fixit, the handyman was found at the bottom of it. This book was published 22 years ago but it still makes a good summer reading now in the 21st century. John Mortimer is a veteran British author who has successfully written for the movies and television. The book will fit nicely in your summer bag, pocket, Nook or Kindle and give you a good summer read.
It is a well known fact that Australia was originally settled primarily by convicts who were shipped there by the Bristish government in the 18th and early 19th century. The Secret River puts a very personal face on what it might have meant to be one of the settlers who had his life reprieved from a hangman’s nose for stealing good to then be faced with a life sentence of exile in a barely inhabited land.
Even before we follow the protagonist of this novel William Thornhill and his wife and small child across the ocean to Australia, we are given insight in to the desperation which lead a hard working honest man to make stealing an everyday part of his life in order to prove a bare sustenance for his family. Particularly when your everyday life as waterman boatman on the Thames River in London put you in contact with the gentleman gentry, we see how the dreams and aspirations of the poorest man can be seeds seed waiting to sprout if ever given the opportunity. Just as the Americans had its Indians who were here first, the Australians had its aborigines although the latter word was never used in this novel. They were usually referred with some variation of “ black”. They were usually a stealth group off in the woods. How the convict settlers tried to dehumanize them in order to justify to themselves their right to dominance over the land is a good part of psychological underpinning of this story.
Author Kate Krenville was apparently inspired to write this noel during her own exploration of studying the family journey of a distant relative. She appears to have mastered the history, the dialect as well as the interesting trials and tribulations, which her main character and his family might have experienced. The reader gets into their shoes and appreciates their struggle as they battle to hold on to their dreams and their values.