The book became, unwittingly it seems, the first of a trilogy ultimately concerned with what conscious is and does. The second book, This is Your Mind on Plants (2021), extends Pollan’s project to three mind-altering compounds found in plants: opium, caffeine, and mescaline, and the third, A World Appears (2026), is his attempt to discern consciousness itself. Here I cover Pollan’s investigation into consciousness across the three books, the results of which frustrated him and required a reconciliation.

The Trips Begin

In How to Change Your Mind, Pollan gives a brief summary of the bumpy history of psychedelics. He recounts how the intense and well-supported interest in them as therapeutic agents during the 1950s was almost completely snuffed out in the 1960s when “a moral panic about LSD engulfed America, and virtually all psychedelic research and therapy were either halted or driven underground” (p. 185). The panic reached its apogee when counterculture movements and their leaders, among them Timothy Leary of “turn on, tune in, drop out” fame, were seen as threats to mainstream society in general. The few remaining embers, though, reignited in the 1990s and by 2006 serious interest in psychedelics revived and research into clinical use resumed through legal means. Structures were in place allowing psychedelic use for specific purposes, opening the way for Pollan’s investigation.

Pollan arranged three separate “trips,” one each for the psychedelics LSD, psilocybin, and 5-MeO-DMT (i.e., “The Toad”). He carefully chose a tour guide for each one. He came through these sessions with what he interpreted as a dissolution of his ego, which made more room for his consciousness: “I was present to reality but as something other than my self” (p. 264). After these experiences and interviews with many scientists, psychologists, counselors, and users, Pollan constructed an argument about how the altered consciousness states psychedelics produce can offer benefits to individuals who are healthy or sick, and to societies that are stable or fractious, by sending “a life or culture down a new path” (p. 407). He is inspiring, vague, and fantastical at times; he gets more so in his follow-up book, Your Mind on Plants.

There’s No Place Like Home

Pollan expands his investigation of consciousness-altering substances by marrying it with his passion for plants and gardening. Therefore, he need not look further than his kitchen and garden for sources serving his interest at this stage: opium (poppy), caffeine (coffee and tea), and mescaline (San Pedro cacti). He explained his rationale for choosing these three mind-altering agents:

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

Pollan received guidance and supervision for his trials of opium and mescaline. As a self-described “heavy caffeine user,” he withdrew from it by giving up coffee and tea, thinking he could make inferences about caffeine effects through reverse engineering the experience.

While Pollan describes the effects these three agents had on his consciousness, he went further morphing from his role as an investigative journalist into roles of historian and anthropologist. Pollan covers how opium, caffeine, and mescaline altered the consciousness of millions of people through the millennia, and in doing so, says they figure in world history and human development, often in rather breathtaking terms. Opium spurred “the Romantic revolution in poetry” (p. 31). “Caffeine was the perfect drug not only for the age of reason and the Enlightenment but for the rise of capitalism, too” (p. 119). “The sins of slavery and imperialism, in a global system of production…could only have been fueled by caffeine” (p. 138).

While he does not credit mescaline with having contributed to human progress in such grand scales, Pollan speaks of its power in healing the most devastating wounds. But insofar as affecting consciousness, for him, mescaline does “what all psychedelics do—not so much change how we feel inside as imbue the world around us with never-before-appreciated qualities” (p. 217).

Pollan may have imbibed too much caffeine while writing this book judging from some of the conclusions he makes, but it may have fueled his subsequent quest to understand just what consciousness is rather than just what it does to his mind and its impact on world history. What he found on this quest, or more appropriately, what he didn’t find, became the basis for his next book, A World Appears.

Pollan Trips into a Cave

If psychedelics and mind-altering plants can change consciousness, then, as Pollan surmises in describing his objective with A World Appears, “consciousness is, at its core, a material phenomenon…[or there is] at least some credence to the idea” (p. xx). So off he goes on more trips, this time to experts working on finding a discernible form of consciousness, a trip that in the end fails, but still produces some value towards the way we think about artificial intelligence.

Pollan’s trips takes him to four ports of call, or “four different dimensions of consciousness” (p. xxxi). His first stop is “sentience,” which refers to consciousness as where in living beings sensations are perceived and responses to them generated. The next stop is “feelings,” the awareness of biological phenomena, the communication link between the body and the mind, serving homeostasis, for example. “Thought” is Pollan’s third stop, accounting for “the stream of thoughts that all of us experience every waking moment” (p. xxxii). His trip ends at “self,” or the ’I’ that takes in all of our experiences.

Each trip constitutes a chapter comprising what is known about consciousness from a particular dimension. Pollan describes and evaluates them with the help of people involved in their development. Across the four dimensions, he consults or references a wide range of experts including among others: neuroscientists, physicists, biologists, philosophers, psychologists, screenwriters, novelists, poets, and Buddhists. He combs through their theories, constructs, data, analogies, stories, and metaphors. Pollan, nevertheless, comes up empty, and is “abashed to say I know less now than I did when, naively, I set out to unravel the mystery of consciousness” (p. 225). It took several days in a cave at a Buddhist retreat high in the mountains of New Mexico for Pollan to reconcile with this outcome, “to let go into not-knowing.” He wound up accepting consciousness “as less a scientific or philosophical puzzle to be solved and more as a practice…Consciousness is a miracle, truly, and remains the deepest of mysteries” (p. 239).

So be it, but what then are we to make of the artificial intelligence industries’ determined attempts to integrate or discern consciousness in their machines? Pollan might say they will need a miracle.

Citations:
Pollan M. How to Change Your Mind. Penguin Books; 2019. 464 pages
Pollan M. This Is Your Mind on Plants. Penguin Press; 2021. 288 pages
Pollan M. A World Appears: A Journey into Consciousness. Penguin Press; 2026. 320 pages

Links:
My blog post elaborating on Pollan’s How to Change Your Mind is here, and on Your Mind on Plants is here.

Along with cohost, Dan Albrant, here’s a link to our podcast episode in which we focus on: consciousness, spirituality, and mysticism as what is at work in the effects psychedelics produce, and how they may delineate limits to biomedicine (rational or not), that is, how they brighten or blur the line between classic biomedicine and whatever isn’t. 

Edited by Lucy Bruell.
Web Image: Cave Man, Tim Brown, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

The diagnosis and clinical management of various mental disorders are aided by knowing the predisposing, precipitating, and perpetuating factors in a given case. Both the themed album and the full-length movie of Pink Floyd’s, The Wall, depict these factors in the course of the main character’s—”Pink’s”— mental health deterioration through music and film. In this episode, we draw from selected songs on the album and from selected scenes in the movie connecting the three factors with particular behaviors Pink manifests. In the process, we show how they are used in medical education and training in real time.

Joining us is Dr. Anthony Tobia, who is the campus chair in the Department of Psychiatry at the Rutgers School of Medicine and is also the Service Chief of Psychiatry at Robert Wood Johnson Barnabas Health in New Brunswick, NJ. Dr. Tobia is certified by the American Board of Psychiatry and Neurology and is certified in internal medicine and psychosomatic medicine. He also holds a secondary appointment in the Division of General Internal Medicine at Rutgers. Dr. Tobia is the Director of Graduate and Interprofessional Education at Rutgers University Behavioral Health and has received the Outstanding Clinical Faculty Member Excellence Award in 2018 and 2019. He is an active contributor to the medical literature with publications, reviews, and abstracts. Dr. Tobia’s educational interests include the merging of popular culture and the field of behavioral medicine, which is evident from this episode and from his previous appearance on the podcast episode featuring The Who’s Tommy. Along with Dr. Tobia for this episode is Kevin Frederiks, who at the time of recording, was a fourth-year medical student at Rutgers.

Citations
For the recorded album: Pink Floyd. The Wall. Columbia Records, 1979.
For the movie: Parker, Alan, director. Pink Floyd The Wall. MGM, 1982.

Link
Please send us comments, recommendations, and questions here, or email to: ru***************@***il.com.

Thanks to Dr. Anthony Tobia and (by now) Dr. Kevin Fredriks for their interesting and insightful contributions to this episode. 

Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts.

Web image by Russel Teagarden

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Why did you write this book?

I’m encountering more and more people over the last few years, particularly post-COVID, who have the perception that the categories we use in psychiatry have a kind of fixed, objective, and quite rigid reality. Twenty years ago, when I started as a GP, I might have seen somebody who said, “I feel anxious all the time,” whereas now I’m more likely to meet somebody who’ll say, “Well, I have generalized anxiety disorder.” That’s a shift in the way that society talks about mental illness. At the same time, a lot of people are questioning these categories’ usefulness, so there’s a paradox—a sort of polarization.

I wanted to write a book which explains, from my perspective, A, how the way we think about mental illness has always been shifting and evolving. How we think about mental illness changes with culture, time, and geography. And B, if we can adopt a more flexible and humble approach to our current understanding, that actually offers more hope to patients. Because believing “I have generalized anxiety disorder,” rather than “I feel anxious,” can sometimes be helpful, but it can also box you in and become self-fulfilled. I’m seeing that same shift across the whole spectrum of mental illness and suffering, and the book is a call to question that and reassess where we’re at in the mid-2020s—and a plea for a little bit more kindness and flexibility.

What would that look like in practice?

For example, if somebody comes to me saying, “Well, I have generalized anxiety disorder, so I can’t do this stuff,” part of my work is to help that patient adopt a more hopeful perspective: that there are strategies that they can learn, that there are medications that can help, and that our mind is shaped by many different influences. There may be explanations for their anxiety that have to do with the brain and neurotransmitters and so on. But in most people, there are also more influential factors that have to do with their early childhood experiences and their current social setup, the precarity of their relationships or their economic situation, the quality of their sleep, or the substandard nature of their housing. There are all sorts of other factors that are having a bearing on their anxiety that I would seek to help them explore, rather than them just blanketly saying, “I have generalized anxiety disorder—can you give me the pill for that?” I’m trying to encourage my patient to say, “Yeah, there are pills that can help. But there are all these other factors that we need to think about. And do I really find that label helpful?” For some people, once you start to dig into it, they don’t.

We can extend that way of thinking to people who’ve had a psychotic episode. Between 10% and 20% of people who have a psychotic episode will never have another. For substantial numbers of people, their psychotic episode is actually a product of all sorts of stressors that are on them at that time. If you can find a way to modify their stressors, put them in a more supported state, and understand what place that episode has in the story of their life, you can then make a story that makes sense of that episode as the product of a uniquely difficult moment in their life. That can help people get over that episode and also, I hope, make it more likely that they don’t have subsequent episodes. Or, if they do, then they’re able to return fully to their normal functioning in between.

You write, “For the last forty years much Western psychiatry has behaved… as if our thinking is a simple matter of chemical levels in the brain. The truth is far more complicated.” For example, a 2023 study you cite challenged the serotonin theory of depression. [1] Why do you think that the chemical imbalance narrative has persisted?

There’s a number of reasons. That hypothesis came through at a time when our lab technology was starting to be able to measure neurotransmitters, and it offered a good story. If you become depressed, you feel as if you’re lacking something—as if you’re lacking some kind of fuel or energy. That lack translates very easily, in our metaphor-making minds, to the idea that there must be some kind of lack between our brain cells.

At the same time that this technology was becoming widespread, there was the promotion of a drug which seemed to help: Prozac. There’s no doubt that SSRIs do make a difference. Again and again, they’re shown to be better than placebo. The effect is probably a lot smaller than a lot of the drug companies would tend to promote in their materials, but they do help, and I continue to prescribe them. But what that study you’re referring to was saying was that, even if these drugs help, they don’t help by boosting serotonin levels. We can’t find evidence that substantiates that theory.

The first half of the 20th century was governed by Freudian ideas. Psychiatry in much of the West was dominated by those kinds of psychoanalytic ideas. Then, during the ’50s and ’60s, as we started to develop tricyclic antidepressants and experiment with other kinds of antidepressants—the first were anti-tuberculosis drugs—the idea grew that there might be a chemical solution, which fit very well into our technologically and pharmaceutically focused medical culture. Then, from the late ’90s, there was a huge explosion of the idea that, actually, a lot of it was genetic.

Now, even the idea that neurotransmitters are strictly excitatory or inhibitory is starting to be questioned. Essentially, the whole picture is vastly more complicated than the neurotransmitter hypothesis from the ’90s suggested. I don’t take that as a great failure of the hypothesis; it was an attempt to make sense of something very complicated, and the drugs that spoke to that metaphor are useful and are still among some of the most widely prescribed in the world. But the fact that we no longer think that low mood is purely because of low serotonin is a really positive step forward. It encourages us to embrace more fully the biopsychosocial approach to mental illness. The field of psychology and psychiatry is not known for consensus, but one thing everybody agrees on is that it’s not just biology, it’s not just psychology, and it’s not just sociology—it’s all these influences that have an effect on our mental health.

Are there other common assumptions about mental illness that you think deserve closer scrutiny?

Every age uses the metaphor of its highest technology to make sense of the mind. In the 19th century, the mind was famously described as an enchanted loom; the mind was thought to be weaving our experience, moment by moment. We’ve now got these very pervasive metaphors of wiring, which I find quite unhelpful because the brain is nothing like a circuit board. It would be like a circuit board made of jelly that can fix itself. So I think the wiring metaphor, although it has its uses, has gone too far because it’s too deterministic. It’s not organic enough.

Half a century ago, Stanford psychologist David Rosenhan wrote, “A psychiatric label has a life and an influence of its own.” To what extent can psychiatric labels help, and to what extent can they hinder?

There’s a lot of controversy about the Rosenhan experiment. [2] He’s been accused of being a charlatan and fabricating quite a lot of his data. But I think the value of his reflections still stands. I’ve definitely seen in my clinical practice that people will be treated differently because of a label that has been put in their notes, even though that label might have changed several times. I’ve had patients who’ve had four or five different labels in the course of their career, while they’ve had actually pretty much the same kinds of experiences and distress throughout all of those.

What I find really helpful in my conversations with patients is the fact that we don’t always have to give a label. If someone is really keen for one, then I’m happy to explore that with them and tell them, “These are the psychiatric categories that are on offer in the current edition of the DSM. Some people find them really useful, but with every new edition of the manual, they change, so they’re not describing something discrete, fixed, or in the natural order of things. They’re a way of describing and approaching distress, so let’s talk about how much they would be helpful for you.”

Now, in the U.S., I understand that labels can be essential because of insurance-based medical payments. In a U.K. context, a label may not be as useful because our psychiatric services are organized differently. I gently explore with each patient how much for them it’s going to be transformative. If it’s going to help ease their suffering and get them the treatments that they want, then I embrace it and help them get the one that fits best. But if it’s not going to be transformative in terms of how they can access care, then I tend to try to avoid giving a label because that can allow a level of optimism and dynamism about their state of mind. It more genuinely reflects the possibility of change and adaptation, rather than risking somebody changing the way they think of themselves.

As human beings, we’ve got such a huge tendency to put shame on one another. What labels seem to do in our current moment is absolve people of that shame in a really helpful way. I’ve had patients say to me, for example, that until they got their diagnosis of ADHD, they felt so ashamed of not being able to focus properly at work, and what that label did was offer a kind of absolution from that shame because it said, “There is this category of being that is separate from you and which seems to be affecting you, but it’s not your fault.” That can be wonderfully liberating. In those kinds of situations, I’m often keen to embrace the label if it’s going to help the patient cast off their shame. But I’m also questioning: Why have we got that shame? Isn’t it a pity that people often feel that they need to embrace a medical diagnostic label in order to rid themselves of that shame?

What strengths do primary care physicians bring to mental healthcare compared to someone more specialized?

One great advantage of somebody in my kind of role is that I’m embedded in the community. I often know the whole family, and I’m seeing people for all kinds of other problems which have a bearing on their mental health. I’ve become more aware of the connections between families and individuals; a specialist only sees the one individual with a particularly distressing problem—for longer appointments, granted, but removed from that context.

There’s a wonderful GP writer in the U.K. called Iona Heath, who has written a lot about the fact that it’s in the primary care consulting room where suffering is either given a label and understood within a medical model, or not. Some people see primary care physicians as essentially holding a line, or acting as some kind of gatekeeper, between the huge mass of human experiences that are out there and which ones become medicalized. A lot of people will come and see me about something fairly banal—almost to try me out, to try and figure out whether I’m going to be kind, compassionate, friendly, or approachable. Once they’ve tried me with a symptom that they’re not too fussed about, then they’ll risk sharing the one that they’re really worried about.

As a primary care physician, I feel I have a very privileged role: You’re not part of the family, but you’re not part of the establishment—you’re somewhere between the two. I’m often the first port of call for people hoping to make sense of their experience.

One line from your book that struck me: You write that today’s DSM categories will one day “seem as overconfident as the old phrenology charts.” How literal or hyperbolic do you mean that comparison to be?

Phrenology was debunked about 130 years ago. By the late 19th century, it was already starting to lose its traction because good thinkers were realizing it was a load of rubbish. If I could fast forward to 2176 and ask the doctors of that time what they’ll make of the DSM-5, I don’t think they would see it as phrenology, but they would certainly see it as utterly obsolete and unhelpful to them because it’s a cultural document of the West in the early 2000s. We can’t imagine what Western culture is going to look like in 2176. I’d argue that it’s quite likely that it will be very different from our current culture, that our neuroscience and genetics will have progressed in huge leaps and bounds, and that the organization of our society—while it may not have progressed—will have changed utterly. The DSM-5 will be of purely historical interest. When I was born in the ’70s, they were using the DSM-II, which is now considered very much a historical document—and that’s within my lifetime. I’m hopeful that the DSM-6, if and when it ever appears, is going to be an improvement on the DSM-5.

What inspired the book’s title?

From my chair in the clinic, I don’t see people’s minds as brittle and fragile. I see people as immensely resourceful, resilient, adaptive, and dynamic. People are incredible; they always amaze me with their ability to get over even the most extraordinary difficulties, suffering, and traumas. In my seat, I see the mind as far more unfragile than a lot of the rhetoric in our culture suggests.

The Unfragile Mind: Making Sense of Mental Health
Gavin Francis
Publisher: The Experiment, New York. 2026. 256 pages.

[1] Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 28, 3243–3256. 
https://doi.org/10.1038/s41380-022-01661-0

[2] In the 1970s, Rosenhan and eight pseudo-patients feigned auditory hallucinations to gain admission to a dozen psychiatric hospitals across the U.S. Once inside, Francis writes, they “declared themselves free of the hallucinated noises, but found it very difficult to be believed, and be discharged” (p. 47).

Web image created from book cover by Medhum.

Zauner was 25 when her mother was diagnosed with an aggressive, late-stage, mid-life cancer. Zauner was a rebellious child, resentful of Umma’s version of tough love. Growing up the lone Asian student in her Oregon community, she felt both othered at school and an outsider among her mother’s Seoul relatives when she visited them each summer. Just as she was beginning to appreciate her Korean heritage and understand her mother’s love, she learned about Umma’s diagnosis.   

The first half of the memoir exuberantly brings to life scenes from Zauner’s childhood and her brief post-college years as a musician in New York City. Surprisingly, without hesitation, she paused her makeshift career and flew west to care intensively for her mother. Attempting to heroically save Umma, Zauner zealously learned to prepare the native foods they shared. “I would radiate joy and positivity,” Zauner pledged. “I would learn to cook for her—all the things she loved to eat, and I would single-handedly keep her from withering away” (69). Her optimistic culinary efforts produce a poetry of exacting descriptions of the flavors and textures and preparation of those foods. It’s grimly ironic that the chemotherapy her mother endured wiped out her ability to taste or digest Zauner’s loving offerings of health.  

The second half turns from living with Umma to living without her. Wishing to sustain her bond with her mother as Zauner grieved, she continued preparing her Korean family’s recipes. Walking down H Mart’s redolent aisles released “waves” of sorrow that mark the enduring ebb and flow of her grief. Unsuccessful with conventional therapy, she found cooking the best form of self-care: “Every dish I cooked exhumed a memory. Every scent and taste brought me back for a moment to an unravaged home. Knife-cut noodles in chicken broth took me back to lunch at Myeong Dong Gyoja . . . The kalguksu so dense from the rich beef stock and starchy noodles it was nearly gelatinous. My mother ordering more and more refills of their famously garlic-heavy kimchi” (212-213). An image of abundance in the midst of loss.

Zauner’s detailed descriptions of cooking and consuming invite readers to her table, reminding us—as previous celebrated writers have—of the power of the senses to evoke memory and the power of food to strengthen human bonds. Food also powers Zauner’s self-understanding and the unexpected transformational love for her mother: “The culture we shared was active, effervescent in my gut and in my genes, and I had to seize it, foster it so it did not die in me . . . If I could not be with my mother, I would be her” (223-224).  

Zauner’s writing is itself active and effervescent. Through her grief, she holds a steady, unflinching gaze on cancer and death. As she writes candidly about her family, Zauner is critically reflective about her own life. Her writerly achievement is the immediacy of her felt experiences, her grief and her joys made palpable. “Let me feel this,” she courageously writes, dismissing her Korean family’s admonitions to withhold tears (202). An unforgettable image of the process of loving transformation that Zauner experienced unfolds in her description of making the Korean staple kimchee. It is a slow, exacting process of fermenting cabbage that at first strikes her as “controlled death” because “[l]eft alone, a head of cabbage molds and decomposes. It becomes rotten, inedible. But when brined and stored, the course of its decay is altered. Sugars are broken down to produce lactic acid, which protects it from spoiling. Carbon dioxide is released and the brine acidifies. It ages. Its color and texture transmute. It exists in time and transforms. So it is not quite controlled death, because it enjoys a new life altogether” (223). 

As if miraculously, a few years after Umma died, Zauner’s itinerant music career took on a new life. The band she has fronted, Japanese Breakfast, recorded the album Psychopop with a song she wrote about her mother, “In Heaven.” Then they toured the U.S. and South Korea. Although her mother was skeptical about a musical career, Zauner imagined that Umma would be “glad that I had finally found a place where I belonged” (233). 

Crying in H Mart: A Memoir
Michelle Zauner

Publisher Alfred A Knopf
Place Published New York
Edition 2021
Page Count 239

Web photo by Portuguese Gravit

Tuner follows Niki White (played by Leo Woodall), the apprentice of piano tuner Harry Horowitz (Dustin Hoffman), and a tragic genius. Once a gifted pianist, Niki developed hyperacusis—an increased sensitivity to sound that prevents him from playing the piano and requires him to wear hearing protection at all times. After Harry forgets the combination to his safe, Niki teaches himself to open it by listening to the lock’s subtle sounds. When Harry is later hospitalized, Niki begins cracking safes to pay off his mentor’s mounting medical debt.

By the film’s second act, Niki’s increasingly dangerous work jeopardizes both his safety and his relationship with his girlfriend Ruthie (Havana Rose Liu), leaving him to confront the consequences of his actions. When Niki makes amends in the third act, Uri (Lior Raz), the leader of the criminal group in which he has become entangled, viciously beats him. The injury costs him part of his hearing but enables his return to the piano.

Tuner is engaging, beautifully constructed, and emotionally resonant. At the same time, it turns disability into a plot device. Marking director and co-writer Daniel Roher’s fiction debut, the film fully embraces the artistic license afforded by the genre, casting hyperacusis as a superpower rather than focusing on the condition’s often debilitating effects.

To be fair, Niki mentions that, at one point, even the sound of his own voice was agonizing. He is constantly on guard against potentially harmful sounds. When confronted with barking dogs, smoke alarms, air horns, and gunshots, he winces and clutches his ringing ears.

But the impact is fleeting. In real life, exposure to noises like these can permanently worsen hyperacusis. Furthermore, the hearing disorder is not a “superhuman” tool; many individuals with hyperacusis show normal hearing thresholds. For those with milder cases, everyday sounds like a running dishwasher can cause significant discomfort. In more severe cases, even near silence can be excruciatingly painful. One wonders how Niki could tolerate the clicks, clacks, and whirs of piano keys and combination locks (another creative liberty: modern safes are designed to thwart auditory decoding).

As disability studies scholar Rebecca Garden argues, there are “tensions between the lived experience of illness… and the conventions that shape the representations of those experiences in published narratives.” [1] In other words, the demand for drama often precludes verisimilitude, instead favoring a happy ending of triumph over adversity. Niki’s liberation from his condition is narratively satisfying; another, if less commercially successful, film might depict a similar character learning to live with it.

In his seminal text The Wounded Storyteller: Body, Illness, and Ethics (2013), sociologist Arthur Frank enumerates three types of illness stories: restitution, chaos, and quest. The restitution narrative “has the basic storyline: ‘Yesterday I was healthy, today I’m sick, but tomorrow I’ll be healthy again,’” the chaos narrative “imagines life never getting better,” and the quest narrative “accept[s] illness and seek[s] to use it.”

Tuner follows a kind of restitution storyline: Yesterday Niki was a healthy prodigy, today he cannot perform because he is sick with an exploitable “superpower,” but tomorrow a thief will effectively cure him by rupturing his eardrums. The film also features aspects of the quest narrative; to quote Frank, Niki “returns as one who is no longer ill but remains marked by illness”—that is, no longer hyperacusic but partially deaf. Niki is figuratively reborn with a new purpose, embodying the film’s Spider-Mannish moral logic: “With great power comes great responsibility.”

Despite these quest elements, Niki’s story remains fundamentally a restitution narrative. Frank notes that such narratives are “culturally preferred” and calls for “an enhanced tolerance for chaos.” To that end, future films might engage more directly with the lived experience of hyperacusis. Ultimately, however, Roher’s approach is understandable and even commendable, using the possibilities of cinema to draw attention to some of the challenges of a rare, if romanticized, disability.

[1] Garden, Rebecca. “Telling Stories about Illness and Disability: The Limits and Lessons of Narrative.” Perspectives in Biology and Medicine, vol. 53, no. 1, 2010, pp. 121–135.

Photo credit: Black Bear

The trajectories of tuberculosis (TB) and opera met in the mid-nineteenth century most notably with the production of La Traviata in 1853, and then La Bohème near the century’s end. With eminent scholars Linda and Michael Hutcheon, we talk about how these trajectories converged and how these resulting two operas then brought attention to the medical effects of the infection and the sociocultural influences on its spread. We also discuss how the discovery of germ therapy during the time between the staging of these operas affected the way social behaviors changed accordingly, that is, from understanding TB as hereditary to understanding it as infectious. We play audio clips from parts of the operas pertinent to perspectives provided. 

A big thanks to Drs Linda and Michael Hutcheon who in addition to providing their expertise and perspectives during the podcast, also contributed ideas for the production. 

Links
– The combined bio for Linda and Michael Hutcheon.
– The New York Metropolitan Opera on-demand video service where you can get access to high-quality video productions of La Traviata and La Bohème among many other operas and performances. (There could be a 7-day free trial available).
– Homer Simpson performing as Rudolpho in La Bohème singing Oh Dio! Mimi!
– We covered the effects of TB as an aesthetic ideal of beauty during the nineteenth century as represented in paintings earlier in episode 5.

Audio Credits
La Traviata
Preludio (National Philharmonic Orchestra; Richard Bonynge cond London Records 1979)
Prendi, Quest’È L’Immagine (Orchestra of the Opera House, Rome; Tullio Serafin cond; Victoria de los Angeles (Violetta); EMI Records Ltd 1960; digitally remastered 1992)

La Bohème
O Soave Fanciulla (Berlin Philharmonic; Herbert von Karajan cond; Mirella Freni (Mimi); Luciano Pavarotti (Rudolfo); Rolando Panerai (Marcello); London Records 1972)
Si. Mi Chiamono Mimi (ibid)
Mimi È Una Civetta (ibid)
Mimi È Tanto Malata! (ibid)

La Bohème photo from wikicommons

Most chapters are titled after a medical condition (exceptions are “Hubris” and “Melodrama”). Some of the headings are familiar – Trauma, Infarct, Aneurysm, Meningioma. Other chapter titles flaunt delicious medical terminology that mingles the mysterious and the poetic with nomenclature such as Angor animi, Neurotmesis, Photopsia, and Anaesthesia dolorosa.

Included are riveting accounts of both mundane and seemingly miraculous patient outcomes. One success story involves a pregnant woman losing her sight due to a brain tumor that compresses the optic nerves. Her vision is restored with an operation performed by the author. Her baby is born healthy too. But tales of failure and loss – malignant glioblastomas that are invulnerable to any treatment, operative calamities including bleeding of the brain, paralysis, and stroke – are tragically common. The author describes his humanitarian work in the Ukraine. He admits his aggravation with hospital bureaucracy and is frequently frustrated by England’s National Health Service.

Sometimes the shoe falls on the other foot, and the doctor learns what it is to be a patient. He suffers a retinal detachment. He falls down some stairs and fractures his leg. His mother succumbs to metastatic breast cancer. His three month old son requires surgery for a benign brain tumor.

As his career winds down, the author grows increasingly philosophical. He acknowledges his diminishing professional detachment, his fading fear of failure, and his less-hardened self. He becomes a sort of vessel for patients to empty their misery into. He is cognizant of the painful privilege it is to be a doctor.

The title of Do No Harm is spot-on. After all, this commandment is a crucial caution to all doctors. And for neurosurgeon Marsh, it signifies the restraint he must exercise in his medical decision-making. His approach to the doctor-patient relationship features a gentle medical paternalism that incorporates plenty of honesty and kindness. He writes about his struggle (and occasional clumsiness) with breaking bad news.

His professional life is portrayed as paradoxical – constant anxiety and contagious confidence, phases of futility and strings of inspiring operative accomplishments. The gift of forgiveness, how uncertainty tortures doctors, and the process of dying are significant topics for Marsh. In the last few decades, there has been a proliferation of medical memoirs. Do No Harm rises above them all. The book informs doctors that it’s okay to be vulnerable and fallible, as long as they are also compassionate, truthful, and caring. 

Primary Source Do No Harm: Stories of Life, Death, and Brain Surgery 
Publisher Thomas Dunne Books/St. Martin’s Press 
Place Published New York 
Edition 2015 
Page Count 288 

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

John O’Connor, whom I happened to interview on May 5, explores a similar dynamic unfolding amid today’s psychedelic renaissance—a movement rife with magical thinking that he sees as something of a religious revival—in his delightful and enlightening new book A Short, Strange Trip: An Untold Story of Magic Mushrooms, Madness, and a Search for the Meaning of Life in the Amazon. 

Some Westerners are appropriating sacred plants while divorcing them from the traditions that gave them meaning—“colonizing them in reverse,” as American ethnobotanist Glenn Shepard puts it (p. 211). For example, ayahuasca use, despite widespread belief, may not date back thousands of years. Instead, O’Connor argues that the practice “rarely existed where Indians remained isolated from Western meddling” (p. 222). Its expansion beyond the Río Napo began relatively recently with Jesuit missions in the early 17th century and later accelerated through 19th-century rubber camps along the major river systems of the Amazon Basin. Through Western tourism, ayahuasca has come to be portrayed as “an ancient ritual for slaking our insatiable thirst for Indigenous salvation and/or for increasingly extravagant highs” (p. 223). 

During our meeting, O’Connor told me he does not “think there’s ultimately harm in appropriating a plant if you find it therapeutic, useful, or even life-saving—which a lot of people are reporting these drugs can be.” 

At the same time, he said, “we need to have an honest, good-faith conversation about where these drugs come from, what their actual Indigenous uses are, and what they are.” 

To write the book, which explores humanity’s broader relationship with psychedelics, from ancient religion to modern medicine, O’Connor worked with the Uitoto people to retrace an expedition undertaken some 50 years ago. Into the Colombian rainforest—home to begonias as red as blood and butterflies as wide as hubcaps—ventured scientific researcher Dennis McKenna and his older brother Terence, the visionary whose “tangled beard hung like an oriole’s nest past his chin” (p. xix). Weary of the war on drugs and fueled by utopian fantasies, Terence’s army of psychonauts sought a legendary hallucinogen that would turbocharge their DNA and “hasten a return to our preindustrial and preliterate past” (p. 284). 

In reality, Terence and his disciples did not transform into “eternal hyperdimensional beings” or travel via “flying saucers of the mind… ‘into the plenum of being’” (pp. 94, 30). Nor did they propel “human evolution forward to its next stage” by connecting to “the mind of nature itself” (pp. 284, 11). But they did experience auditory and visual hallucinations that led them, in a manner not unlike schizophrenia, “to adopt a new narrative interpretation of the world” (p. 95). 

Armed with the spore prints they’d brought back from La Chorrera, the McKenna brothers were “among the first, if not the very first, to successfully cultivate magic mushrooms at home, sparking a major leap forward in psychedelic history” (p. 202). In 1976, they published Psilocybin: Magic Mushroom Grower’s Guide; this April, half a century later, President Donald Trump signed an executive order expediting research into the therapeutic benefits of psilocybin and other substances of its ilk. 

O’Connor mentioned that one such mind-altering drug, ibogaine—made from the root of a Central African shrub—has shown promise in treating post-traumatic stress disorder and substance use disorders. 

“That’s great,” he told me, “but it also has a habit of slowing people’s heart rates considerably,” among other life-threatening side effects.  

“People are diving into these treatments as if there are no potential risks,” O’Connor, who teaches journalism at Boston College, added. “They don’t work for everyone—they’re not a magic bullet.” 

The remainder of the interview, which follows, has been edited for length and clarity.  

Why did you choose Terence as the focal point of the book? 

I hadn’t heard of him, and I pride myself on knowing about eccentric, overlooked weirdos from the psychedelic ’60s and ’70s. I was doing a lot of retail therapy online during the pandemic, as were many folks, and I came across his book, True Hallucinations (1989), totally by happenstance. I hadn’t known anything about it, bought it, and put it on the shelf for two years.  

I finally opened it one day and started reading. I had some preconceived ideas without really knowing anything about Terence or his subject. I thought it was probably some hippie-dippy thing about machine elves, and it sort of is that, but that’s not all it is. It’s a great narrative and just fascinating—it just captured me. 

Terence postulated that psilocybin mushrooms “played a crucial role in human evolution, giving our remote ancestors a jolt in language and cognition” and “turning Homo erectus into Homo sapiens.” While there’s nothing in the fossil record to support Terence’s “stoned ape theory,” according to anthropologist Laura Weyrich, advances in proteomics and DNA-sequencing technology could potentially indicate whether ancient hominids at least ate psychedelic mushrooms.  

How plausible do you think stoned ape theory is? 

When I first began looking into it, I was like, “Oh, this is so ridiculous.” I was embarrassed to ask these various paleoanthropologists, archaeologists, and researchers about it. I was like, “Oh my God, I can’t ask this, but I have to.” But it turns out that, as a thought experiment, many of them also found it interesting. It’s not something that I think is ultimately really provable. You could find some tangential scientific evidence, but you’re probably never going to get a smoking gun. 

Terence had a lot of theories—some relatively sane-seeming, like the stoned ape theory, and some completely batshit theories that have no basis in science or reason. But I sometimes liken him to Sigmund Freud, or maybe some of the kookier analytic philosophers, where you read it, it sounds kind of good, and then you get to the end and think, “Well, that’s probably 95 percent bullshit, but it still enriches my worldview.” I feel more enriched for having read it. That doesn’t mean it’s true, and I don’t put much credence in it, but it’s fun to entertain, and I do think it enriches the way I think about the human mind and human possibility. 

You also mention how “what drove [you] to write this book was in part a procession of deaths and their aftermaths” you and your wife endured starting in 2019. Would you elaborate on that? 

About a year into writing the book, my son, who was four at the time, fell ill unexpectedly, out of nowhere. He was in and out of the hospital during those days. It really brought us face to face, for the first time as parents, with real suffering and grief, and with being totally out of control when it came to finding a remedy for him. There was just no help to be found anywhere. I started thinking about grief and suffering, and how much of it was around us.  

Then there was this kind of cascade of deaths—just a lot coming at once over the span of a couple of years. It made me wonder what psychedelics, at least on a therapeutic level, potentially have to offer people: some relief.  

Another thing: My father was, weirdly, at the same time, starting to consider psychedelic-assisted therapy to treat his depression and longstanding addiction to alcohol. Maybe a year before, I’d given him Michael Pollan’s book, How to Change Your Mind: What the New Science Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (2018). Because my dad had been in and out of therapy, rehab, and 12-step programs for many years, I was like, “I don’t know if you’ve heard of this, but I’ve been reading about non-traditional approaches to treating alcohol addiction, including psychedelics.” I don’t think he ever read it, but it did start a conversation between us. 

What surprised you most while researching the book? 

Reading Terence, I hadn’t realized that psilocybin mushrooms were not indigenous to La Chorrera—that they were essentially a foreign import [1], and not something used by the people there, certainly not by shamans. 

Another revelation was what “shamanism” actually looks like in the Colombian Putumayo. Terence talked a lot about this sort of psychedelic shamanism. A lot of people do today, too. But it’s just not at all what it seems to be. The Indigenous perspective on and use of things like ayahuasca, or yagé, and other psychedelic plants—at least in the Putumayo, where Terence and Dennis spent much of their time—is vastly different from how I think they’re generally understood or used in the U.S. These substances were generally not used for healing. Until European contact with Indigenous peoples throughout the Amazon Basin, ayahuasca was mostly used in the hunt—to have luck in finding animals—or sometimes to find lost objects or communicate with family members or other tribe members over long distances. But it was definitely not a therapeutic application. That’s starting to shift a little bit now, though, because of this strange sort of cross-pollination that happens so often in history where it’s now being fed back into an Indigenous context. 

I think I went into the book as something of a Terence fanboy. I cooled on him a bit once I spoke with Colombian anthropologists and ethnobotanists and realized how taken out of context many of his proclamations were on psychedelics and the “shamanic” experience. But, by the end, I sort of warmed to him again because I realized that his ultimate project, I think, was really about human wellness and flourishing. I think that’s what he wanted ultimately, even if he went about it in a strange, myopic way focused almost exclusively on the psychedelic experience through psilocybin mushrooms. That’s where I part ways with him. I think the best place from which to grapple with grief, loss, and suffering is through love, tenderness, and compassion—not through machine elves at the end of history, which was, more or less, Terence’s take. 

I was also interested in your discussion of “diagonalism”—what scholars William Callison and Quinn Slobodian characterize as the social-distress-born alliances between the far left and the far right uniting wellness gurus, anti-vaxxers, and conspiracy theorists. 

I was just reading an article by the American political scientist Francis Fukuyama; he calls it this horseshoe meeting of the minds—this ideological vortex where people with otherwise totally divergent political opinions are meeting in the middle on certain issues. The far left, the Make America Healthy Again movement, the Multidisciplinary Association for Psychedelic Studies—even just the friendship between [MAPS founder] Rick Doblin and former Texas Governor Rick Perry [co-founder of the nonprofit Americans for Ibogaine], who had one of the most conservative legislative agendas in recent memory. That friendship seems genuine—and maybe even necessary to advance these drugs beyond their current legal status. 

In 2023, MAPS hosted the world’s largest psychedelic conference, which you describe as laden with snake oil pseudoscience and lacking in diversity, equity, and inclusion. Almost a year later, an FDA advisory panel rejected MDMA-assisted therapy for PTSD, citing safety concerns and questions about data validity. Critics alleged that MAPS’ drug development arm failed to disclose data showing sexual misconduct by therapists and increased suicidality among trial participants. A former MAPS volunteer called MAPS an exploitative and abusive cult that functions “more like a religious movement than a scientific organization.” Similar concerns emerged at The Johns Hopkins Center for Psychedelic and Consciousness Research. An ethics complaint accused founding director Roland Griffiths of “acting as a ‘spiritual leader’ rather than a scientist” and influencing participant outcomes through religious symbolism. 

Additionally, a Columbia psychiatrist reviewing the field noted a relatively high rate of  irritability, anxiety, insomnia, and other adverse events, and called for more “rigorous assessment” of psilocybin-assisted therapy.  

How do we balance the potential of psychedelics to promote empathy and well-being with the risks? 

Terence said a lot of completely bullshit things about psychedelics—even dangerous things at times. You see that in the movement today, where a lot of these wild, unsubstantiated claims are being made about drugs that, yes, have real healing potential for many people, but for others, such as my father, don’t work at all—and arguably cause more harm than good. 

We should be sane and sober about this. We can champion these drugs while still having a lucid conversation about their efficacy, limitations, and safety concerns. 

[1] One of my favorite passages from the book is “Darkly gilled, with distinctive golden halos and pink veils around slender stems the color of bruised flesh, they were easily identifiable as Psilocybe cubensis… Likely brought to the Americas by Spanish missionaries via the dung of zebu cattle—rangy saltwhite beasts with enormous, scythe-like horns—Psilocybe did especially well in the humid pastures of La Chorrera. Amazonian shamans, who knew more about psychoactive plants than anyone on earth, had no use for these foreign imports. To Terence, however, they were living manifestations of the divine” (p. xx). 

A Short, Strange Trip: An Untold Story of Magic Mushrooms, Madness, and a Search for the Meaning of Life in the Amazon 
John O’Connor 
New York: Sourcebooks 
2026 

Tooker depicted waiting for a more specifically governmental bureaucracy in his painting, “The Government Bureau.” In that painting, the waiting people are reproduced several times to emphasize their anonymity, and the multiple bureaucrats peer out from frosted windows with only their eyes and noses visible — bringing to mind the concept of the “medical gaze” promulgated by the French philosopher,  Michel Foucault.

In another Tooker painting, “Ward,” he renders patients’ anonymity and a sense of abandonment in the hospital setting–with government bureaucracy invoked by the American flags hanging on the wall.

Image Credit
The Waiting Room, George Tooker, 1959. Collection of the Smithsonian American Art Museum. Image used for educational and critical commentary purposes.

George Tooker documentary videos from Columbus Museum

The short story follows a woman who has been sent by her physician to a colonial mansion in the country as treatment for postpartum depression. The woman, who remains nameless, is constantly dismissed and belittled by her husband, who is also a physician. He speaks to her patronizingly and ignores her protestations that the “treatment” she is being given is making her worse instead of better. She is told not to think, and not to write, and her husband believes that since he sees no reason for her suffering, it does not exist. She is kept upstairs in the mansion’s nursery, isolated behind bars and gates that she believes to be there for children’s safety, when in actuality they function to keep her imprisoned. As time passes, the woman believes that she perceives something in the wallpaper and becomes convinced that it is a trapped woman. She believes the woman is confined behind bars within the wallpaper, which mirrors the trapped feelings that she herself is experiencing living day in and day out inside the confines of the nursery. Her desire to help the woman escape, which mounts to a frenzy, is reflective of her own desire to be free from the nursery and the rest cure.

Throughout the story, the titular wallpaper functions almost as another character as it’s brought to life in the narrator’s mind. She contrasts the vitality of the wallpaper with the “dead paper” upon which she is writing the journal entries that make up the narrative. Her fascination, and disgust, with the wallpaper drive the story as she investigates its pattern and condition, and then ultimately determines that there is someone living within it. The narrator’s disdain for the paper is obvious in her descriptions; for instance, in her first mention of the wallpaper, she writes “I never saw a worse paper in my life” (p. 793). She later writes that the print was “One of those sprawling flamboyant patterns committing every artistic sin” (p. 793). On the topic of its hue, she writes that “The color is repellent, almost revolting; a smouldering unclean yellow…a dull yet lurid orange in some places, a sickly sulphur tint in others” (p. 793). For all of her disgust with the wallpaper, and its damaged and torn condition, she still finds herself fascinated by it, and this fascination turns into obsession, which later turns into madness.

“The Yellow Wallpaper” works so effectively because it allows the reader to step into the mind of a woman as she is driven to madness. The structure of the story, which is told in an epistolary format, adds to the reader’s affiliation with the narrator as there is an intimacy in reading her journal entries and being in on the secret that she is writing against her husband’s orders. This affiliation helps to build empathy between the reader and the narrator, which contributed to the concern that I felt for the woman when she slowly lost her mind. If the story helped to save people, as Gilman hoped, it did so because it made them see the human being at the center of the “illness” and “treatment,” forcing them to understand what truly happens when you isolate someone and take away their ability to do what brings them joy. We bear witness as the woman loses her mind, leaving us with an intimate picture of what the rest “cure” could truly do to someone’s psyche. Instead of viewing postpartum depression solely as a condition to be treated, “The Yellow Wallpaper” makes readers realize that there is a person at the center whose needs and voice deserve attention.

In a patriarchal era in which women’s voices and lived experiences were ignored in favor of what the men around them deemed to be “best,” “The Yellow Wallpaper” offers an important and valuable perspective – that of the woman herself. By placing the female patient’s voice at the forefront of her story, Gilman gives her narrator the agency that had previously been stripped from her, to tell the story of her postpartum depression and how the prescribed treatment drove her to madness instead of restoring her health. It is a reminder to each of us that the voice of the patient is of paramount importance in any instance in which an embodied condition is being treated. When we ignore the patient, and what they need, they are lost, pushed to the background, and left to disappear into their own metaphorical wallpapers.

Works Cited
Gilman, Charlotte Perkins. “The Yellow Wallpaper.” The Norton Anthology of American Literature, edited by Nina Baym and Robert S. Levine, W.W. Norton & Company, 2012, pp. 804.

Originally published by The New England Magazine, Boston, 1892

Image Credits
Illustration for ”The Yellow Wall-paper” by Joseph Henry Hatfield, 1892 from Wiki Commons
Book cover by Small, Maynard & Company, 1901 from Wiki Commons
Web image from Medhum

Film ReviewVideo

Obsession and “The Yellow Wallpaper” 

Rudy Malcom May 29, 2026

The film highlights the peril of love that demands possession.