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

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.

Before modern medicine, superstition mediated pregnancy and childbirth. Once, divine wrath or distressing mental images risked what was called a monstrous birth. To reduce risk today, pregnant women consult prophetic prenatal technologies and the ceaseless cacophony of digital media. Twice pregnant, New York Times pop culture and internet reporter Amanda Hess found herself both drawn to and repelled by media advice and the collection of data enticed by apps or insisted on during clinical encounters.  

Her book Second Life: Having a Child in the Digital Age—part wry memoir, part savvy investigative reporting—asks whether current technologies deliver a better, if not perfect, baby or the maternal well-being they augur. She, even more significantly, worries about the consequences, personal, relational, and ethical, of pursuing perfection.  

Hess couldn’t resist interacting with chatty, advice-giving apps. One first tracks her fertility and then, in weekly installments, shows her what a developing “creepily realistic CGI fetus” looks like. (Another app likens fetal development to the temptations on Parisian bakery shelves. A macaron, for instance.) Visual creepiness aside, Hess has unsettling thoughts about surrendering intimate information about her body to unknown recipients. She discovers that a popular app she regularly consults was developed by two brothers in Belarus backed by venture capitalists. Its surveillance exposed her to endless marketing schemes that hardly considered anyone’s well-being or financial resources. Curious about the history of fertility tracking before and after apps, Hess discovers a throughline of troubling eugenic ideologies. It travels through the advice of a popular pregnancy influencer. 

Deep into Hess’s first pregnancy, a “concerning” routine ultrasound detected what could be Beckwith-Wiedemann syndrome (BWS), a rare genetic condition. Its possibility sent Hess anxiously scanning the internet, against her doctor’s advice, for medical information and possible maternal causes. Was it the wine? The Ativan? A fever? Her age? Unspecified guilt followed. But neither the internet, genetic testing, nor her doctor could reassure her about a cause or the possible extent of the condition. The internet images she sought of children with the full range of BWS anomalies hardly quelled her anxieties. Only after her son’s birth was a form of BWS confirmed.  

Hess sympathizes with the wish to deliver a healthy baby and the temptation to seek any available service or technology to that end. After all, that’s what she wanted. However, the prospect of birthing a child with an anomalous body leads her to question the meaning of the ubiquitous parental qualification: “As long as the baby is healthy.” Healthy, she finds, translates to normal. Anticipating a not-normal child makes her feel protective of her son even before his birth. After it, she deflects thoughtless remarks from strangers about his enlarged tongue protruding from his lips. (Corrective surgery later enables less compromised breathing and speech.) She and her husband care for and about him for the distinct person he is. About her initial anxieties about his body, Hess writes, “My nightmare . . . ended when I met my son.”  

Hess’s standout chapter “Growth” recounts her evolving response to her son’s imperfections and her efforts to manage others’ IRL and internet responses to him—a task she finds essential to parenting him. I hope this chapter is widely read, certainly by future parents, but also by clinicians, genetic counselors, and those who teach them.  

Some accounts of caring for an imperfect child cast the child and the parental relationship as special. Some view chronic illness or disability as a familial burden. Hess does neither. Instead, she folds caring for her son into the course of her life and her family’s. In that way, she continues a contribution of Michael Berube’s complicated 1996 Life as We Know It, however, adding a millennial’s navigations of current medical technologies and media static. Hess further envisions a world that participates in the care of all children, one that refuses to blame or isolate families with less-than-perfect children. That world would reduce parental anxieties more than screening for concerning “problems.” Philosopher of care and mother of a profoundly disabled child, Eva Kittay, would agree. 

Some readers might say that Amanda Hess’s financial and other resources make her generous perspective possible. She agrees. She’s half of a two-parent family. As journalists, she and her husband have more flexible schedules than countless other parents. But in the world Hess encourages, parental status would be irrelevant to their child’s care. 

Without being prescriptive, Hess’s lively, self-reflective story provokes readers to think twice about rejecting imperfect children—anyone’s—and to notice the eugenic logic underwriting rejection. Her book tests the claim that ever-evolving technologies enhance maternal well-being, empower parental choice, and guarantee healthy babies. (Ironically, a researcher Hess encountered reported on increasing evidence of BWS in IVF conceptions, many intended to screen for anomalies.) In fact, far more children are permanently harmed during their lives than are born ill or disabled. Rather than relying on the billion-dollar industry of prenatal testing, aren’t we better off, Hess asks, accepting and taking better care of all children however they’re born? 

Second Life: Having a Child in the Digital Age
Amanda Hess  
Doubleday, 2025, 272 pages 

These changes have not all been for the better. Perhaps you have noticed such unsettling changes yourself. A child in a restaurant is glued to a tablet screen, probably the last resort of a weary parent trying to enjoy their first peaceful meal in days. A group of tourists in Paris marvels at the Eiffel Tower, not as it is, but as it appears through their phone camera and on their phone screen. Neighborhoods have become quieter and less lively, as children have retreated from the streets and hunkered down at home with their phones. 

Jonathan Haidt, a social psychologist at the NYU Stern School of Business, elaborates upon these ideas in his book The Anxious Generation. In this book, he describes the dual trends of increasing smartphone/screen-based engagement, driven by perverse economic incentives of technology companies, and decreasing real-world, human-to-human play, driven by over-protection from modern parents. The collision of these forces has defined Gen Z, born between 1997 and 2012, as the most anxious and depressed generation of our time. 

In the book, Haidt notes that the tactics of technology companies to drive increased user engagement have been well documented by activists such as Tristan Harris. Much like tobacco companies in the mid to late 20^th century, modern technology companies prey on young users (e.g. children) as a source of future/recurring revenue, and fight off consumer protections through aggressive lobbying campaigns at the government level. As a result, children are spending record numbers of hours on smartphones, increasingly isolated from the real world and irritable when deprived of their digital drugs. Haidt also observes that the technology problems of girls and boys are unique. For example, girls are significantly more prone to social media addiction and the associated psychological disturbances such as distorted body image and self-worth. On the other hand, boys are much more avid users of video games and pornography, which reduce their desire for real-world play and romantic relationships. 

Haidt also notes that over a longer but overlapping time period, children have been overly protected from real-world responsibilities and real-world play. He attributes these new attitudes to the changing media landscape and how crimes are portrayed in the news, as well as legal challenges which have incentivized parental overprotection. In one example, he describes a pitiful incident in which an eight-year-old child was seen walking the streets alone, and a concerned passerby called the police to report an “abandoned child.” In this case and many others, parents have been held responsible for this absurd new “crime”, a sight which would have been entirely commonplace 30 years ago. Haidt highlights the irony of how the real-world, full of rich experiences, appropriate risk-taking, and character-building responsibilities has been overly regulated by our society, whereas the digital world, rife with dangers for growing adolescent minds, has been almost entirely unchecked, unregulated, and ignored.  

Bringing people out of the digital world and into the real world is a formidable task. One strategy that Haidt found success with was to encourage people to reconnect with a sense of awe in the world. Awe is a vague concept, but can be defined as a feeling of wonder inspired by the sacred or sublime. The real world is full of such awe-inspiring moments, if only we could stop to notice them. In a comically simple exercise, Haidt encouraged students in his university course to take a walk through Manhattan without their phones or headphones, and then to write about their experience on this “awe walk.” The written reflections were so beautiful that he included excerpts of his students’ work in the book to illustrate how such simple measures could have such a profound impact. One such excerpt is reproduced below: 

For children who have no choice but to grow up in the digital era, Haidt attempts to boil his recommendations down into four rules for a healthier childhood:  

1. No smartphones until high school. 

2. No social media before the age of 16. 

3. No phones in schools. 

4. More independence, play, and responsibility in the real world. 

He recognizes that while these solutions are simple, their implementation is anything but. As a society, we face a daunting collective action problem as it pertains to technology and real-world experiences. Such problems require collective solutions, and Haidt encourages parents to get together, organize, and raise their children together in a real-world oriented manner. While broader changes in school policy may seem out of reach, Haidt encourages struggling schools to get inspired by the numerous case studies of schools that went phone-free and experienced positive changes by almost every metric, within a matter of two to three years. 

Some may say that our society is too far gone to reverse these negative changes, but this is certainly not the case. In fact, people are more skeptical now than ever of the negative role of technology in our lives, and collective action on this problem may be easier now than it ever has been before. As we sit perched on the precipice of a new technological revolution in artificial intelligence, this sentiment has already garnered potent opposition to unchecked technological advance and implementation. Will we learn from our past mistakes? Unfortunately, our track record is not encouraging. Only time will tell how far we go before we decide we need a detox. 

The Anxious Generation 
Jonathan Haidt 
Penguin Press, New York City, March 26, 2024, 400 pages
Web Photo by Joel Fulgencio 

For nearly two decades after the fatwa was issued, his literary career flourished, and he became a visible spokesperson for freedom of artistic expression. As president of PEN, Rushdie promoted initiatives to protect and promote the careers of writers living in fear under repressive political regimes. In August 2022, he was invited to speak on this topic at the Chatauqua Institution, an adult education and social movement. On a sunny summer morning, as he sat on the stage of the amphitheater to begin a public conversation with his interlocutor at Chatauqua, he noticed a man dressed in black suddenly rise up from the middle of the audience and charge the platform. There was no security at Chatauqua that day or any other day because the violent world had never intruded into the bucolic space of the institution during its entire 148 year history. Rushdie found himself rooted to the spot, frozen and unprepared to defend himself as the attacker stabbed him seventeen times – in his eye, his face, his neck, his chest, his abdomen, his hand. Heroic people charged the stage and subdued the assailant. Miraculously, Rushdie survived and he was helicoptered to the nearest trauma center for emergency treatment. Knife is a meditation on the event, the ordeal of rehabilitation that Rushdie had to endure, and his reaction now that he is healed, and his life is restored.

Knife is a visceral book that is grounded in the harsh reality of crazed, religious zealots and painful, tedious rehabilitation. It is different from the magical prose that characterizes much of Rushdie’s writing. The events are described in excruciating detail. One can feel the hurt and sense the worry etched into the pages. It is testament to the many doctors and nurses and therapists who took part in his bodily reconstruction and long convalescence. Most of all it is an inspiring testament to his wife who had the fortitude to be at his bedside throughout the entire ordeal . Rushdie gives her most of the credit for his stamina, the tenacity and resilience that he displayed during the long months after the attack. He substitutes an imaginary dialogue with his attacker in lieu of a face-to-face encounter in prison to express his contempt for his religious intolerance. Rushdie and his wife summon the courage to revisit the Chautauqua stage one year after the attack and achieve some degree of closure on the event.

There is much humanity and wisdom in these pages, lessons on how to confront and overcome adversity. One might question what we, mere mortals, can learn from a singular person like Rushdie who was blessed with such an abundance of human and professional resources to draw on as he recuperated from his injuries. However, differences in fame and access to expertise do not ultimately carry the day. Instead, it is how we as individuals, regardless of our wealth or social status, are able to tap our inner strength and utilize the help and support of our loved ones. The task for us all is to draw on our cognitive and psychological reserves and convert life-threatening tragedies into surmountable setbacks. If, like Rushdie, we succeed, then we will have reached a more mature and meaningful embrace of life in all its beauty and complexity. Rushdie’s story played out in the international limelight. The narrative also unfolds every day on countless hospital floors and rehabilitation units the world over as people strive to overcome injury and illness in their own private world. Rushdie’s template is universal.

But for readers of the Medhum website, I suggest that there is an unspoken but instructive message lurking in Rushdie’s story, specifically for health care providers, doctors and nurses both. There were unexpected turns of events during Rushdie’s recovery. It was not an uninterrupted march from near death to healing. He experienced disabling complications from medications that were prescribed for rational clinical reasons, iatrogenic problems. In one case, severe urinary retention requiring repeated painful bladder catheterization, it was only through the astute observation of one of the clinicians that the causative medication was stopped and the problem spontaneously resolved. In another, he experienced symptomatic hypotension, a disabling side effect of one of the drugs prescribed for him. There was a cancer scare when an imaging study performed to assess his urological problems. suggested he might have a lesion in his prostate. He experienced excruciating pain when his eyelids needed to be sutured together to protect his injured eye. In each case, Rushdie was reassured that things were proceedings according to plan and that things should improve with time. Follow up tests were done to monitor the prostate anomaly and confirm improvement in his symptoms but the discomfort and unease lingered in his body and his mind. The anxiety that the problems might not resolve was ever present in Rushdie’s consciousness. 

Doctors know that recovery from injury or illness is a time consuming process that rarely occurs overnight. They are right to encourage their patients to take the long view of their health problems, to reassure them the treatment is usually a continuing proposition. But even for a highly intelligent patient like Rushdie, the doctor’s confidence in how things were going could never completely allay the fear that his broken body would not heal, and his health would not be restored to what it had been pre-knife attack. Daniel Kahneman and Amos Tversky won the Nobel Prize in Economics in 2002 for groundbreaking studies that explored how people assess loss and gain and make financial decisions. Kahneman expanded on their studies in behavioral economics and proposed that rational thought utilizes two operational modes. System 1 is rapid and instinctive in contrast to system 2 which is slower, more deliberative, and more reasonable. Channeling this work by Kahneman, there may be two systems operating during recovery from bodily injury. Doctors may be employing an analog System 2 method of thought as the disease is steadily halted, reversed, and repaired. Patients, however, live through illness in a binary System 1 approach of thought: sick or back to normal. We physicians would do well to remember that the only words our patients really want to hear from us when they come to us for care are, “You are now fine. We can stop the medications and stop the follow up. You are back to normal.”

Knife
Salman Rushdie
Knopf 2024, 209 pages

While in Oslo, Norway visiting family, Russell Teagarden went to the National Museum (Nasjonalmuseet) to speak with Øystein Ustvedt, who is a curator and noted expert on the art of Edvard Munch. The interview concentrates on Munch’s work expressing emotional dimensions of anxiety, illness, grief, and suffering. Ustvedt talks about how Munch’s life story explains the sources for his empathy and artistic inclinations, identifies and discusses the paintings particularly effective in expressing emotions illness and suffering generate, and considers how Munch’s work could benefit health professions students and practitioners. Russell’s 5½-year-old granddaughter teaches him how to say, “National Museum” and “goodbye,” in Norwegian, with varying success.

Links to paintings discussed:
Puberty (1894)
The Sick Child (1885)
Spring (1891) 
Sick Girl (Christian Krogh, 1881)
Death in the Sickroom (1893)
The Spanish Flu (1919)
Between the Clock and the Bed (1940-1943)
Melancholy (1892)
The Scream (1893)

Link to Russell Teagarden’s blog piece in According to the Arts on Øystein Ustvedt’s book, Edvard Munch: An Inner Life.
Link to National Museum (Nasjonalmuseet), Oslo

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image from Wikipedia Commons

We feature James Dickey’s poem, Diabetes, with our guest, the renowned physician-poet Dr. Jack Coulehan. We discuss insights the poem offers about the trajectory of type 2 diabetes from the time of symptom onset until the time a balance is achieved between maximum compliance with disease management requirements and the compromises an acceptable lifestyle can necessitate for many individuals. In addition to providing his perspectives on how the poem expands on the biomedical components of diabetes in recognizing effects such as fear, anxiety, frustration, and oppression, Dr. Coulehan recounts how he has used this poem and others in teaching medical students and residents. He also tells stories of particular instances in which he used poetry as part of the care he provided certain patients, and as a way to connect with them. 

Links:
Dr. Jack Coulehan’s bio and posts on Medhum.org

The poem, Diabetes, and the comparative biomedical text discussed can be seen here in Russell Teagarden’s blog, According to the Arts. 

Dr. Coulehan’s poem, I’m Gonna Slap Those Doctors, which was central to one of the stories he told, can be accessed here. And, his poem, The Man with Stars Inside Him, which was central to another story he told, can be accessed here.

In this episode, we make a distinction between illness as the subjective perceptions of a health problem and disease as the pathological basis of a health problem. This distinction is explained in much greater depth here in According to the Arts. 

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Álvaro Serrano