Back when I was doing my internship at Pennsylvania Hospital, I was so surrounded by history I felt like I was working in a museum. Even the china we dined on in the hospital cafeteria sported the original historic pattern. And when we finished our training, a brass plaque with our names went up on the same wall as the plaques of our predecessors going back to the 18th century.

At the time, none of this was widely known. But fortunately, Pennsylvania Hospital now has an actual museum, open to the public just in time for the nation’s 250th anniversary. The Pennsylvania Hospital Museum is compact yet chock-full of art, architecture, artifacts, and documents, and has at once become a must-see destination in Philadelphia.

Although Bellevue Hospital has roots that go back to 1736, it started out as an almshouse. Pennsylvania Hospital was the first institution in the colonies founded specifically as a hospital, established in 1751 by Benjamin Franklin and Thomas Bond. The 1756 building housing the museum is a National Historic Landmark. Not only is it considered an important example of Georgian architecture, but its cornerstone even bears an inscription by Franklin referring to King George II.

The landscaped grounds are a serene oasis in the middle of Philadelphia’s Society Hill neighborhood and include a Physic Garden containing herbs and plants used for medicines in the 18th century.

As one enters the building, the first room encountered is the pharmacy, which remained in use until 1927 and now contains interactive displays. A fire engine purchased in 1803 sits in the foyer at the base of a grand staircase. After ascending to the second floor, visitors enter America’s first medical library, a handsome wood-paneled room containing more than 13,000 volumes from floor to ceiling, including one of the nation’s most complete collections of medical books published between 1750 and 1850.

The third floor houses the nation’s oldest surgical amphitheater. In the era before electricity, it was illuminated by skylight, so surgeries could only be performed on sunny days. (I must confess that we interns used to sneak into this room when on call. It was spooky in the middle of the night!)

For me, as a psychiatrist, the highlights of the museum were the exhibits on mental health. I have previously written in MedHum about Benjamin Rush, often called the father of American psychiatry, whose portrait is on view here. Rush served on the staff at Pennsylvania Hospital from 1783 until 1813 and was known for his groundbreaking and humane treatment of the mentally ill. Metal shackles once used as restraints are also on display, although hopefully they predated Rush’s tenure.

Another psychiatric pioneer whose portrait hangs in the museum is Thomas Story Kirkbride, who came to Pennsylvania Hospital for residency training in 1834. When the psychiatric wards exceeded capacity and a satellite facility was built on 101 acres in West Philadelphia, Kirkbride was named superintendent. His ideas about the layout and design of mental institutions became highly influential, leaving an imprint on hospitals throughout the country.

Initially called the Pennsylvania Asylum for the Insane, the new campus eventually became known as the Institute of Pennsylvania Hospital. I completed my residency training there, but over time it was no longer financially viable, and it closed in 1997.

How fascinating to learn that Francis Scott Key, of “The Star-Spangled Banner” fame, wrote a poem titled On Visiting the Pennsylvania Hospital. And to see 18th-century anatomical casts used for teaching at a time when formal dissection was illegal.

There is so much history in this museum that I could not absorb it all in one visit. With its addition, Philadelphia further demonstrates its role as the cradle of American medicine. Indeed, one would have to travel to London to find a larger assemblage of medical historical sites.

In one very busy day—or a more leisurely two-day trip—a visitor can now experience this museum, plus the College of Physicians of Philadelphia and its famous Mütter Museum, while also stopping to see The Gross Clinic by Thomas Eakins. (The painting alternates between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, but will spend 2026 at the latter.)

Bravo, Philadelphia!

Benjamin Rush:  Reflections from a Psychiatrist 

Guy Glass 09.02.24 0

A founding figure in American psychiatry, known for pioneering reforms, but also controversial for his treatments and complex contradictions in beliefs and practices.

For more information about the museum, visit Pennsylvania Hospital Museum.
Web image from Wiki Commons

In advance of the event, Guy Glass has had the opportunity to speak with Margo Weishar about her play: 

Guy: 
Hello Margo. It is such a pleasure to speak with you. For anyone who may be deciding if they want to come to the reading, can you tell us a bit about the play and the subject matter? And about how you became interested in writing about Elizabeth Blackwell. 

Margo: 
What really interests me is people who break out of the norm. 
People who do things that are completely extraordinary, and what motivates them to do that, and what is their personal cost in doing that. 
Elizabeth Blackwell became the first woman to graduate from medical school in the United States, and then she had a career in promoting women in medicine. But I also wanted to show her as a human being. The only pictures we have are of an old woman, but she was a vital, curious, intelligent, daring, brave person who fought against incredible odds to get where she was. And so that’s who I really wanted to investigate. You know, we all rely on these pioneers to break barriers down so that people like me can walk through them. But what does it take from them to do that? What are the choices they had to make in your own lives to make that possible? So that was the question that really ended up fascinating me. 
 

I got a theater degree because it was something I’ve always done in my life, and I decided I really wanted to formally go and learn. And when I started working with playwright Michael Hollinger, I took a class on solo performance. 
I always loved historical fiction, and I liked plays that were based on historical women. And so, I thought I’ll look at Elizabeth Blackwell as a subject for this solo performance. I started researching and found there was a wealth of primary source information. Not only she, but also her sister Emily became a doctor, and then a lot of her other family members were prominent. There are letters between the nine brothers and sisters in collections at Harvard and at Oxford which I could read online. The more I read and the more material I looked at, the more I felt, wow…this woman had an amazing life! After I did the solo performance, I started developing it as a play. And I really liked where it was going and refined it to the point where I had a public reading at Villanova in May of 2024. 

Guy: 
As you know, I am also a physician-playwright. There are not all that many of us! Can you say something about what it was like as a doctor transitioning to becoming a playwright? Do you feel like you have a special perspective because of being a doctor?  

Margo: 
I feel like my life has had two parallel tracks because I grew up around theater and performing. My father was a scenic designer who was a graduate of Yale Drama School. I am the first and only doctor in my family. I was always that kid who was good at science, but also the lead in the play. I produced and directed the first musical production at Penn med school ever: Sondheim’s Company with a full orchestra, which we put on with all the med students. So, it was always part of my life even during my medical training, although there was a time when I had to kind of put it on the back shelf. 

As far as playwriting, I feel very passionate about telling certain stories that haven’t been told. And now as a woman who has lived a life, had a career, raised three children, and now has a grandchild, I have a lot of life experience. I felt like that kind of voice is somewhat rare in the playwriting world, especially telling stories about women. And especially about women in science. I’ve had the opportunity to play on stage Ada Lovelace, the daughter of Lord Byron, who is credited with developing the first computer and the first computer language. 
I’ve played Maria Sibylla Merian, an artist and biologist in the 1700’s, who drew beautiful studies of insects and plants.
I directed a play about Henrietta Swan Leavitt, a Harvard astronomer in the early 1900’s. I’ve always been fascinated by these incredibly accomplished women who history has ignored. I really felt like that was my impetus for trying my hand at it. I didn’t know if I’d be any good at it. But having my work read by others I could see it was starting to reverberate with people. People were liking it and I was liking what I was hearing. The whole skill was very new to me and quite surprising. 

Guy: 
One of the things I don’t think people who are outside the theater world realize is just how long the development process of a play can take. In what way do you hope the reading at the College of Physicians will help you, and what do you expect will happen next? 

Margo: 
I have another amazing mentor, Ed Sobel, a professor at Villanova and a professional dramaturg. Ed has been working with me on focusing and refining the play. And it is just an amazing thing for me to work with somebody who is so great at what he does. Because he’s asking me questions and really trying to focus on what the essential story is that I want to tell. Having good actors is another good thing. The way people say things will help me to streamline.  

And of course, the last and most important element is how it plays to an audience, somebody who’s seeing it and hearing it for the very first time, what they will come away with and whether I can achieve the emotional impact of what I’m trying to say. As you know, things can be back to the drawing board after that experience. I might hear certain things that really hit perfectly or other things I never even considered. It’s not like a novel, where you finish it, you publish it, and it goes out in the public. You can have multiple full productions before you publish a script because sometimes something doesn’t work in a production. Maybe it’s just the wrong actors. And then you go see it somewhere else and you think, no, that scene was great. You have to see it. It’s a collaborative art, and we need all those people, designers and directors, to interpret what we wrote before we can say, yes, this is the final version. 

It’s interesting. I was in London last week and I got to see a Tom Stoppard play called Indian Ink. This play had been produced 30 years ago. 
And when Stoppard went back to it, he changed the ending. 30 years later! So even Tom Stopford can say yes, I think I can do it better now. 

Guy:  
Thanks for talking to me today, Margo. And best of luck on the reading. 

Margo:  
Thank you! 

4:48 Psychosis raises the question of what constitutes theater. Is this a case study in psychotic depression, a work of art, or both? Can one call language without boundaries a play? What direction remains for contemporary theater to take following total fragmentation?  
 

These concerns have not stood in the way of 4:48 Psychosis being produced - if anything, it seems to be gaining in popularity. What could be stumbling blocks are seen by directors as a challenge to be met creatively. The play’s initial production, at London’s Royal Court (2000) divided the words among three performers. All three initially learned the whole text, and although most lines were eventually allocated, others were voiced spontaneously by different actors from performance to performance. The “action” appeared to take place within the mind of the protagonist. Projections onto a mirror helped create a Rorschach-like effect. As evidence that the play encourages a wide variety of interpretations, in the celebrated TR Warszawa production, six actors embodied discrete characters, creating encounters between a central character and her doctor, family members, or friends. This production, brought to New York in 2014, employed a Polish translation with English surtitles.  Another production, by Theatre du Pif of Hong Kong in 2016, purported to bring “an Asian sensibility” to the play, using a Korean designer and Hong Kong musicians.”  

In conclusion, 4:48 Psychosis is clearly not everyone’s idea of entertainment (one critic likened watching it to being locked in a freezer). However, it provides a beautiful, albeit brutal, window into the depressed, suicidal mind.  

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.  

Primary Source Sarah Kane: Complete Plays 
Publisher Bloomsbury Methuen Drama 
Place Published New York 
Page Count 43 
Web Art: File:4.48 psychose.JPG – Wikimedia Commons 

Before embarking on my project, I reviewed the literature pertaining to the use of plays in medical settings.  Friedrich Schiller, the German playwright (who was, incidentally, a physician), laid the groundwork for the use of theater as an educational tool in his 1784 essay “The Stage as a Moral Institution” calling it “a great school of practical wisdom, a guide for civil life, and a key to the mind” (Schiller, page 252).  In his view, the theatricalization of the “vices and virtues of men” and of “human woe” not only makes them more palatable, but it also actually teaches the audience to be more empathic. 

I found a wide range of milieus in which plays have been used.  In 1938, The Federal Theatre Project, a program sponsored by the WPA, produced a play entitled Spirochete with the goal of reducing the spread of syphilis (Flanagan, page 144).  More recently, dramatic narratives were used by scientists to provide a forum for learning about human genetics; these have been collected in a volume entitled The Drama of DNA.  

A pioneering program that proved inspirational to me is Medical Readers’ Theater, developed in the 1980s at East Carolina University’s Brody School of Medicine. Stories by William Carlos Williams and other doctor writers have been turned into scripts used to encourage dialogue among medical staff, students and the public about a variety of medical issues. These plays are available in anthologies accompanied by discussion questions.   

There are also numerous popular plays which are natural fits for teaching because they illustrate points of ethics, diagnosis, doctor-patient relationship, etc. at the same time as just being entertaining.  Some of the ones I have used include Wit, A Streetcar Named Desire, and Next to Normal.    

While deciding what to do for my thesis project, I was becoming quite taken with Anton Chekhov’s writing through working with Jack Coulehan at Stony Brook.  Previously, although I knew of course that Chekhov had a reputation for being one of the great playwrights, I had had the impression that his plays were a bit boring because nothing much happens in them.  What can I say?  I must just not have seen the right productions.   

I researched Chekhov’s life, read his short stories, and even plowed through Sakhalin Island, the epidemiological survey he wrote about health conditions in a penal colony. As a result, I became an admirer and gained insight into his method.  It does not matter whether there appears to be anything happening or not.  The author’s job is to record what he observes. It is not by chance that this is also the job of a physician.  One can understand why Chekhov might have wanted to continue to practice medicine even after becoming one of Russia’s most celebrated writers.  Chekhov soon became my personal role model as a doctor writer, and it felt like an honor to dedicate my time and energy to his work, and in my own extremely modest way, to add to his dramatic corpus.   

Chekhov wrote over 500 short stories, and doctors play a significant role in about 25 of them.  I chose “A Nervous Breakdown” (1889) and “A Doctor’s Visit” (1898) “for adaptation.  As “A Doctor’s Visit” has fewer characters and is the shorter of the two that is the one I use to teach.  Some students may even have read the original story already because it is so well known.   

The plot may be summarized as follows:  A doctor has been summoned away from the city to see the daughter of a factory owner, but for some reason he sends his assistant instead.  (Perhaps he just did not want to go out to the boondocks.) The assistant doctor arrives at the house and examines the young lady.  After not finding anything wrong, he concludes that he’s been called for nothing. The patient’s mother, who is depressed and overwhelmed, implores him to spend the night instead of going home to his family.  The doctor is not in a position to refuse, but he feels as if his time is being wasted and he is annoyed.  

However, in the short time he is in the factory town, the doctor gets a sense of what it is like in live in such a place. He sees how unhealthy the environment is for the workers. He sees how, despite having lavished a fortune on expensive furnishings, the inhabitants of the house are miserable. Adding insult to injury, a servant repeatedly contradicts him and gets on his nerves.  

In spite of the prejudices he has brought with him from the city, the totality of his experience makes an impression on this doctor. The next morning, he meets with the patient again. This time, he recognizes that she is a sensitive and intelligent young lady, and he now has empathy for what she must be going through. There is a moment of understanding between them. Although it does not perhaps appear as if the doctor has applied any treatment, the patient responds and shows a sense of hope.  The doctor has also changed as a result of this experience. He leaves the house and heads home in a good mood.   

Like general practitioners today, general practitioners in 19^th-century Russia undoubtedly ended up doing a good bit of psychiatry.  Although Chekhov and Freud were contemporaries, there seems to be no evidence that Chekhov was aware of Freud’s “talking cure. “  But even if not, and even if the doctor in “A Doctor’s Visit” does not think he has done anything, the doctor has in fact unwittingly administered a brief psychotherapy session.  The powerful results he obtains with such simple means remind me of some of my own experiences as a psychiatrist.  Sometimes when one uses one’s psychoanalytic theories to make what one thinks are brilliant interpretations, they fall on deaf ears.  Just being present and listening often produces the best outcomes.   

The greatest technical challenge this playwright confronted in dramatizing “A Doctor’s Visit” was figuring what to do about the doctor’s internal thoughts.  There is plenty of spoken dialogue in Chekhov’s story, and I used much of it practically verbatim.   But how to dramatize one’s inner dialogue?  It would be cumbersome to have a narrator describe it, and unnatural to have the doctor verbalize it.  My solution was to create a brand-new character, a young apprentice, someone the doctor uses to bounce ideas off.   I hope audiences and readers feel this was a reasonable compromise on my part.   

My adaptations of Chekhov’s two stories made their debut in 2015.  Since then, “A Doctor’s Visit” has been used to teach students at several medical schools:  Stony Brook, Drexel, New York University, Boston University, Cleveland Clinic, and the University of Pennsylvania.   At all but one of these I introduced the play in person, read the stage directions aloud, and led the discussion.  The text of the play is included in an appendix to this article in the hope that other schools will take it up.  And I am still available to read stage directions! 

References: 
Chekhov, Anton: “A Doctor’s Visit.”  Translated by Constance Garnett.  https://www.ibiblio.org/eldritch/ac/jr/193.h
Coulehan, Jack.  “Cold Eye, Warm Heart: Medicine and Anton Chekhov.” MedHum, October 2, 2025 Flanagan, Hallie. 1940, reprinted 1985. Arena: The Story of the Federal Theatre. New York: Limelight Editions 
Rothenberg, Karen H. and Bush, Lynn Wein. 2014. The Drama of DNA. New York: Oxford University Press 
Savitt, Todd L. (ed.) 2002.  Medical Readers’ Theater:  A Guide and Scripts.  Iowa City: University of Iowa Press 
Schiller, Friedrich. 1784. “The Stage as a Moral Institution.” In Theatre/Theory/Theatre, 250-254.  New York:  Applause 

Web image created based on this vintage illustration from WikiCommons

A Doctor’s Visit:  An Adaptation of a Short Story by Chekhov

by Guy Fredrick Glass

Downloads of this play may be distributed and performed for educational purposes only, with permission of the author.  Dr Glass may be contacted at gf***@*ol.com 

On September 9, 1982, on her 25th birthday, Julie Ridge became the 242nd person to swim from England to France. On April 11, 1991, Ridge was hospitalized for 21 days and unceremoniously received a diagnosis of bipolar disorder I. Julie’s one-woman show Bipolar & The English Channel tells the story of how a casual mile-a-day pool swimmer became an English Channel swimmer in nine short months and her 17-hour, 55-minute zig-zag journey across those grey murky seas. It also tells the less glamorous story of a world-record holding endurance athlete who wakes up one not-so-fine day floridly manic, locked down on an unforgiving New York City psychiatric ward – and her arduous journey back to sanity and a fulfilling life.  

On March 26, The College of Physicians of Philadelphia presented a performance of Julie Ridge’s one-woman show: https://collegeofphysicians.org/events/bipolar-english-channel-one-woman-show In advance of the event, Guy Glass has had the pleasure of speaking with writer and performer Julie Ridge about her work. 

Guy: Julie, I had the privilege of seeing your show Bipolar and the English Channel a couple of years ago in New York. It was informative, entertaining, and inspirational. As you know, I help arrange programming for the College of Physicians of Philadelphia. As a psychiatrist and playwright, theatrical representations of mental health issues are right up my alley. I am so glad it is working out to have you bring it to the College! 

The very striking title of your piece brings together two images that seem completely unrelated, but you fuse them together so convincingly. Can you say something about your background that sheds some light on the title, about your life as a swimmer, and then your discovery of your diagnosis? 

Julie: With the title, I’ve tried to conjure the image of how my life with bipolar disorder and my unlikely swim across the English Channel run parallel to each other and are symbiotically intertwined. My decision to the swim the English Channel came on as spontaneously as a manic episode. I tell the full story in the show, but the germ was planted when a friend who swam two miles-a-day broke his wrist, and I doubled my casual one mile a day in empathy for his mandatory pool abstinence. At the time, I was an actress performing in my first Broadway show and swam for peace of mind and to stay in shape. The story of learning I had bipolar disorder is the subject of the second act of the show – so, I ask your readers to come see it to hear the tale. 

Guy: Can you tell us how and why you decided to turn your story into a show? What is it like for you to perform? What has the reaction to the show been like, especially from the mental health community? 

Julie: After my diagnosis in 1991, I went back to school to get my master’s degree and became a psychiatric social worker. Over time, I’d developed a seminar that told the story of my English Channel swim and bipolar diagnosis. The decision to turn the informal seminar into a show first arose when I discovered I was a single hour shy of collecting my Actor’s Equity pension. I asked all my friends who were still in the theater if they could write me into a contract show, maybe as a person lying behind a couch or something, even just for the first act of one show, and I’d refund them my salary – I just needed that single hour to collect a lifetime pension. A couple of years went by, no offers were made, I was getting closer and closer to 65, so I decided to do it myself. I wasn’t going to lose my pension over one measly hour.  

On the 5th Anniversary of the non-profit organization I founded in memory of my dad, I pulled together the least expensive Actor’s Equity contract possible that would get me that hour. That contract was four staged readings at the Studio Theater on Theater Row off Broadway in New York City. It was the first time I’d disclosed my bipolar disorder publicly and, frankly, I was terrified. But community members, family, buddies from high school and college, and colleagues were incredibly warm and receptive.  

That four-day run led to performances in the United Solo Festival off Broadway for two consecutive years. A performance at my sister’s temple outside of Boston was seen by a friend with connections to the Sedona Festival, which led to another gig at the JCC in Hartford Ct and so on. It’s my hope that I will be able to perform the show each year in venues across the country.  

As for how it is to perform it – I actually have acute social phobia and get terribly anxious every time I perform the show. It’s odd, because performing when I was an actress was easy and highly enjoyable. But those shows were written by other people and not about my life. Doing something so intimate and personal is quite different. I never know how it’s going to land and be received.  

Guy: I see that in addition to Bipolar & The English Channel, there is a documentary film about you. Can you say something about how this came about?  

Julie: Seems there’s a story behind everything! Zac Norrington, a film student at the New School in New York City needed a subject for his Capstone project senior year. Long distance swimming and cold-water swimming was something of personal interest to him because of a near-death experience his grandfather had. Zac brilliantly thought to contact Ned Dennison, the Director of the International Marathon Swimming Hall of Fame (IMSHOF) for recommendations on swimmers he might interview in New York. Turns out that swims I’d done in 1983 and 1985 put me in the record books. My athletic resume in the 1980s was out of the ordinary, and to my amazement, I was inducted into IMSHOF in 1985.  

Ned recommended me and a couple of other swimmers. Zac interviewed a few of us, showed his preliminary work to his class and professor and they all said “forget about the other swimmers. Focus on Julie’s story.” He did. His short documentary BREATHE, is about the intersection of my double swim around Manhattan Island and my bipolar disorder. He submitted the doc to several festivals, we got showings at many of them, including the prestigious ReelAbilities Film Festival. At our last festival, The Greenwich Village Film Festival, we won Best Short Documentary. Zac was a wonderful director, cameraman, editor and producer. He completed the entire movie during the pandemic. I’m very impressed with the work he did culling together our interviews, still photos and archival footage. It’s been an honor attending talk backs to represent the film. 

Guy: Can you tell us about the organization you founded, the Frank Ridge Foundation? What its mission is, why you decided to start it, and about some the foundation’s projects?  

Julie: Ah, the subject nearest and dearest to my heart. Thanks for asking. Frank Ridge is my dad – one of the kindest and most loving dads a girl can be fortunate enough to have. Dad died in 2013 after 90 full years, rich with adventure, and community involvement. Pops supported everything I ever did, unquestioningly and unconditionally. He was by my side stroke after boring stoke for all of my swims, was in Hawaii melting in the heat with me when I completed the Ironman Triathlon and rode side-by-side with me as we biked 3,700+ miles across America. Dad was also a pretty smart businessman, and he left me and my sisters some money. I’ve never had much money – I chose lucrative fields like acting, writing and social work – so what he left felt like a fortune. I took almost half of my inheritance and founded a non-profit in his honor, the Frank Ridge Memorial Foundation, Inc. (frankridgememorialfoundation.org), dedicated to living well with mental health conditions through awareness and understanding. Our primary work is:  

• Creating and facilitating resource-rich topical seminars, using accurate compassionate movies as the springboard for conversation, for community members and mental health practitioners required NY continuing education.  

• Maintaining our resource-rich website. 

• Providing meaningful part-time employment for individuals living well with mental health conditions.  

• And performing Bipolar & The English Channel whenever the opportunity arises. 

I’ve loved working for myself running this organization for the past 12 years and hope to keep on for as long as I am able! 

BREATHE TRAILER: 

VIEW THE FILM HERE: 

https://www.docnyc.net/film/doc-nyc-u-life-in-the-big-apple/breathe/

There is nothing to read on the psych unit but a bulletin board listing the daily activities and some magazines. This makes Chihaya think about her relationship to books, which is a complex one. She muses that “it is every writer’s fear that our books will be the death of us” (p. 11) and humorously writes about how she once had a bookshelf that was so wobbly she worried it would topple over on her. However, the real damage that books inflict may be insidious. The author first began to read as an escape from her unhappy childhood, but she fears she now “love[s] books to a dangerous degree” (p. 20).  They have become her life to the extent that she does not know if she “would be anyone at all” (p.12) without them. A feature of her depression is that she has completely lost interest in reading. She half-seriously coins the diagnosis “bibliophobia” to describe her condition. It will take just the right book to cure her, and when she finds it, she begins to read again, and to heal.  

Over the course of Bibliophobia Chihaya tells us about the books that have been of vital importance to her, many of which she associates with relationships or with stages in her life. Eventually, she reads the DSM about her own psychiatric diagnosis, and she reads books that other people have written about their depression. Working with a therapist, she realizes she needs to move on, and she lets go of her academic career. By the end of Bibliophobia we learn that Chihaya has finally written a book, but it is not the one she was expecting to write. It is Bibliophobia.

Bibliophobia is an unusual hybrid of a book that is part literary criticism part memoir. The author has been influenced by numerous mental health memoirs including recent celebrated works by Donald Antrim, Esmé Weijun Wang, and George Scialabba.

The first chapter, the subsequent emotional journey of the author, and her conclusions all captured my attention. I must confess that much of the rest of this book interested me less for the simple reason that I had not read any of the books the author discusses in detail. I do not even think we have the same taste in literature. However, this may not prove to be a stumbling block to potential readers who are fans of Toni Morrison, Anne Carson or Anne of Green Gables, or who just love reading about books.

According to the American Psychiatric Association, stigma around mental health is common in Asian American communities. One praiseworthy attribute of Bibliophilia is how it calls attention to the challenges that these groups experience in accessing care. Chihaya, was raised by a Japanese father and a Japanese Canadian mother who “did not believe in the concept of mental health; everyone was either fine or just complaining” (p. 49). Growing up with the message that depression is “not for the children of immigrants [but] something that happen[s] to white people in independent films” (p. 7) it goes without saying that Chihaya cannot bring her symptoms to her parents’ attention. Filled with shame, it takes her many years until she can no longer ignore them. Fortunately, Chihaya has given us a book filled with insights that one hopes will inspire others to seek help.

Bibliophobia
Sarah Chihaya
Random House, New York, 2025, 214 pages

References:
https://www.psychiatry.org/psychiatrists/diversity/education/asian-american-patients
Web image from Wikicommons.

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

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

The task of wading through more than a hundred pages of treatment notes induces a feeling of helplessness. This gives us a taste of the author’s own experience of his illness. He often seems to get better or worse without rhyme or reason. Diagnoses come and go. At various times he has been called borderline, obsessive-compulsive, narcissistic or schizoid. He himself questions the literary quality of the notes, considering them “anti-writing” (p.7). Nevertheless, persevering through the material does yield insights for the reader.   

For one thing, the notes document changes in psychiatry over the past half century. The early note takers took their time, and their writing is thoughtful and descriptive. Later notes are comparatively terse and center on the patient’s response to medication. The author suggests that the change reflects a greater fear of litigation. The reality is multifactorial. Less attention is devoted nowadays to understanding a patient’s psychodynamics. Insurance companies pay for symptom relief and want documented results.  

Any sense of tedium the reader might feel from reading the author’s mental health records is made up for by his “tips.” Scialabba gives practical suggestions about pharmaceuticals, what to eat, and how to sleep. Sufferers of depression will be pleased to hear about these things not from a doctor, but from someone who has been through the same ordeal.  

In short, How To Be Depressed is a self-help book that is somewhat out of the ordinary, and whose flippant title belies its serious content. It provides an intellectual perspective on a devastating and common disease. 

Publisher University of Pennsylvania Press 
Place Published Philadelphia 
Edition 2020 
Page Count 146 

Web image created by Medhum.org
An earlier version of this review was published in the NYU Literature, Arts and Medicine Database. 

A precocious young person on a track to success, Wang experiences a manic episode at Yale that leads to her first hospitalization. After a second hospitalization, her college washes its hands of her. Hitting roadblocks time and time again requires her to rebuild her life over and over. This is not a conventional chronological autobiography but rather essays that provide different approaches to the author’s experience of mental illness. The plural “schizophrenias” of the title encompasses the whole schizophrenic spectrum of disorders. As Wang explains, her own diagnosis is “the fucked-up offspring of manic depression and schizophrenia” (p. 10).   

In an essay entitled “High-Functioning” we learn how the author, having been a fashion editor, knows how to pass for normal: “My makeup routine is minimal and consistent. I can dress and daub when psychotic and when not psychotic. I do it with zeal when manic. If I’m depressed, I skip everything but the lipstick. If I skip the lipstick, that means I haven’t even made it to the bathroom mirror” (p.44).   

Later, in “The Choice of Children,” volunteering at a camp for bipolar children makes Wang think about what it would be like to inflict her diagnosis on her own offspring. In “Reality, On-Screen” she attempts to convey the sensation of decompensating to psychosis. And in “Yale Will Not Save You” she considers the failure of universities to accommodate mentally ill students.  

This is a special and rare book. As with Elyn R. Saks in The Center Cannot Hold, Wang’s disability seems not to have robbed her of her cognitive faculties, resulting in a sense of lucidity. Yet, at the same time, we are never far from madness. As a result, the essays glisten like polished jewels while the author’s voice retains the air of authenticity.   

While Wang has understandably had ambivalent experiences, in every case where The Collected Schizophrenias might have lapsed into an anti-psychiatry rant, the author instead considers a range of perspectives. She is devoted to taking her medication, yet she open-mindedly explores alternative therapies, spirituality, and even the notion that her illness might have bestowed talents or some evolutionary advantage on her.   

We should not have to be reminded that once civilians become patients they do not lose their intelligence. Wang writes that “a primary feature of the experience of staying in a psychiatric hospital is that you will not be believed about anything” (p. 98). Indeed, when she is asked how she is doing and she replies she is doing well, she is said to be lacking in insight. At other times, she is advised by certain well-meaning people that given her diagnosis “I should be proud of how coherent I am” (p. 54), and by others “who don’t believe in mental illness… that in other cultures, a person who would be diagnosed with schizophrenia in the West might be lauded as a shaman and a healer…They are likely to be the type who boast about never taking aspirin for a headache” (p. 23).  

There are many insights to be found in this book that should prove eye-opening to mental health practitioners. It should be required reading for anyone who wants to understand the experience of having an illness.   

Publisher Graywolf Press 
Place Published Minneapolis 
Edition 2019 
Page Count 202 

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An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database. 

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

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

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

This is an exceptionally brave book. Antrim does not attempt to whitewash his situation in any way. Surely it is humiliating for someone so successful to acknowledge he has been utterly debilitated. He loses track of time. He gains weight and cannot fit into his clothes. His new book is released, but he is in no condition to help promote it. At first, he objects to being called psychotic but eventually it comes as a relief to know he is understood. One Friday in April will be inspirational to others who have suffered to see how an accomplished person is reduced to being allowed to use his razor only under strict supervision.   

At times Antrim touches on the link between mental illness and creativity. If he had hoped the cathartic exercise of writing about his childhood would have stopped his illness he learns otherwise: “Writing had not stopped my dying. (p. 80)” At another point, his friends joke that his diagnosis “might enhance my literary reputation” (p. 115). Finally, in one of the more poignant episodes in the book, Antrim gets a call from the novelist David Foster Wallace and is encouraged to undergo ECT. He has an excellent response to that treatment, but later learns that Wallace has hanged himself.  

While a diagnosis of psychotic depression fits best with the range of symptoms the author manifests, his point about suicide as a distinct disorder is well taken. In fact, the most recent edition of the DSM (Diagnostic and Statistical Manual) took the major step of including Suicidal Behavior Disorder as a “condition for further study.” This corroborates the author’s experience and means that SBD might be included in a later edition. (see also https://www.frontiersin.org/articles/10.3389/fpsyt.2020.499980/full)   

Those who are looking for an exposé or critique of the mental health system will not find it here. Antrim credits his psychiatrists and the hospital with helping him get through an unbearable time. One Friday in April is a book that will give reassurance to people who have endured suicidal thoughts that if they persist they will get better.  

Publisher W.W. Norton & Company 
Place Published New York 
Edition 2021 
Page Count 141 

Web image from Wikicommons
An earlier version of this review was published in the NYU Literature, Arts and Medicine Database 

Pusey, a talented and enthusiastic guide, provides the backstory to Coram’s project. Coram, a man with a history of supporting good causes, is shocked by seeing the multitude of abandoned children on his visits to London. Parents who are unable to care for their (mostly out-of-wedlock) babies have few options; as many as a thousand of these children a year are left in the streets. While other European cities have well-established institutions supported by the Catholic Church, many Londoners initially believe that caring for them is tantamount to condoning sin and debauchery. In 1737 Coram petitions the King to support the construction of a “hospital” (not in the contemporary sense of the term, but more like an orphanage). His persistence finally pays off, and he even manages to turn his idea into a fashionable cause that receives the support of London society.  

Something that is unique about the Foundling Hospital is that Coram also allies from the start with many of the leading artists of the day. These include artist William Hogarth and composer George Frideric Handel. Hogarth, motivated perhaps by his own impoverished background, becomes a Governor of the Hospital and is active to the extent that he and his wife even foster several foundlings. He executes a portrait of Coram which he donates, and encourages other artists to do the same, so that in due course “the hospital [becomes] England’s first public art gallery and establishe[s] itself as a ‘destination venue’ for fashionable Londoners” (Foundling Museum: An Illustrated Guide, p. 16).  

Because I am a classical music fanatic, I cannot wait to see the famous Handel scores and artifacts that the museum is known for. There is a precedent for a composer to ally himself with a charity; Antonio Vivaldi’s career is deeply linked to Venice’s Ospedale della Pietà, a convent, orphanage, and music school. Handel becomes involved when he is invited to conduct a benefit concert in 1749 to raise funds for the completion of the Hospital chapel. For the occasion, he composes the Foundling Hospital Anthem, which proves to be his last piece of English church music. The text, adapted from Psalm 41 and the Book of Job, begins “Blessed are they that considereth the poor and needy: the Lord will deliver them in time of trouble, the Lord preserve them and comfort them. They deliver the poor that crieth, the fatherless and him that hath none to help him. The Lord will comfort them.” Since Handel is the most famous composer in England, his name ensures there will be a capacity crowd paying high prices for tickets. The following year, Handel conducts a benefit concert of his Messiah in the chapel. The event is so successful that Handel is made a Governor, and performances of Messiah become annual events. When Handel dies, he bequeaths orchestral parts for Messiah to the Hospital in his will so that the tradition can continue. Handel’s will is now on display in the top floor of the Museum. During the London Blitz, the precious document was removed by the curator’s wife who put it in her purse and left the building. When she returned, the room holding the will had been destroyed by a bomb.   

An equally impactful group of artifacts is on display on the first floor of the Museum, along with the following description:

The Foundling Hospital was relocated outside of the city in the 1920s. The earlier site was eventually turned into a children’s playground called Coram’s Fields. Gradually, as Britain moved away from the institutionalization of children and towards adoption and foster care, the Hospital closed. The Museum occupies a building in the same neighborhood as the 18th-century original and incorporates some of its interiors and architectural details. The magnificent Court Room, where the Governors conducted their business, is one of the best surviving Rococo interiors in the city.  

The spirit of the Foundling Hospital endures in the charity now known as Coram, one of the foremost voluntary adoption agencies in the UK. The Hospital’s tradition of receiving support from artists also continues. The Museum’s temporary exhibitions and commissions provide a space for contemporary artists to “enter into a dialogue with their eighteenth and nineteenth-century forebears” (ibid, p.81). Lastly, the establishment of Foundling Fellowships named after Coram, Hogarth and Handel (the recipients of which have included such illustrious artists as Julian Lloyd Webber and Emma Kirkby) ensures that the legacy of the institution will live on.  

References: 
https://medicalmuseums.org
This site contains a wealth of information about London’s medical museums, including the Foundling Museum, as well as information about Richard Pusey’s medical history tours.