The collection opens with a poem, “Dedication” (p.1), dedicating the poems that follow to those “dear friends” who share, and so understand, the sufferings of ongoing illness. The implication is that healthy people cannot, yet, truly enter that world and, in fact, “fear” those who must live there. Yet Silver’s poems are a way into that universe. Tender and fierce, the poems in this collection seem to arise fully formed from the deepest part of Silver’s existence. The poems in section I present us with the harsh realities of illness and the anticipation of loss. In the acknowledgements, (p.72), the author notes that the poems in this section are “in honor of my sisters with inflammatory and advanced breast cancer.” In “Advent, First Frost,” she likens that “feathered prophecy” to “a bowl of frozen tears” (p.6) and in “Stage IV,” she writes that she is “taboo, now,” that she and others use words that once embarrassed them, “courage, prayer, miracle.” Even so, she is aware that “Our passports have been stamped– / our wrists and collar bones have been marked” (p.7). In a lovely prose poem on page 11, she writes in memory of her friend, Susan: “Ulysses will sail the storms till he dies. And so, my dear ones, will we” (p.11), combining, as she often does, the reality of approaching death with hope, dignity, and strength. In “Leaving the Hospital” (p.23) and “On a Line from Virginia Woolf’s Diary,” Silver celebrates the return, even if temporary, to life: “And the day takes my body back simply, / the way a mother dresses her child” (p.14). For me, the most moving poem in this section is the title poem, “I Watched You Disappear” (p. 22-23). It is a litany of regret, loss, anger, and pain, related not in poetic images but in plain and deeply human language: “I hate spring, its prettiness. / Your heart kept beating. Why didn’t it just stop?” 

Section II consists of seven, short one-stanza poems based on images from Grimms’ fairy tales. It seems that the first two lines of each poem serve as metaphorical statements about the realities of advanced breast cancer. “Owl Maiden” begins “No transformation’s instant. / Her hair fell out first, replaced by quills” (p.29). “Strawberries in Snow” begins “Belief comes easily to the ill. / Miracles fall from their lips like gems” (p.31). And “The Flowered Skull” offers these opening lines: “The magician finds them, young or old, / mothers, maidens–to him–no matter–” (p.34). The final poem in this section is a tale told to her son, Noah. In “The Hazel Tree,” Silver is the mother who “died and grew into a tree,” “each nut a word she’d grown to tell her son / now that her speaking human voice was gone” (p.35).  

In Section III, she turns, as she did in her first collection, to poems about her family. She visits again the (actual) doors of her life (“Doors” p.39), expresses regret at being impatient with her son, “Ubi Caritas Deus Ibi Est” (p.41), and in other poems examines moments of her family life, especially those shared with her son, father, sister, and husband. This section’s poems rarely mention illness, yet as they share family stories, they hint at the inevitability of loss. The final poem in this section, “Sea Glass,” ends with lines that could be applied as well to the way poems might be born from the wages of a life: “Something salvaged, sunlit, / gem-like. Something saved / from the grinding into grit” (p.55).  

Section IV, like section II, contains only seven poems, three of them commentaries on paintings and, through those commentaries, observations on illness and suffering as well. “Late Renoir” speaks of how the artist painted to “smudge away doubt” and to submerge “the mutilations of war, his dead wife, / the black he banished from his palette” (p.59). The long poem “Valentine Gode-Darel (1873-1915)” is a reflection on the five paintings by Ferdinand Hodler that captured his lover’s sickness, decline, and death (p.60). “Portraits in the Country,” (page 63), offers a glimpse into the poet’s resignation and acceptance of death, a mindset supported by her faith in both the human and the holy: “But I will not rush to put down my sash. / Instead, I will turn the leaf of my book. See with what gentle gravity God / lets it hover, in balance, then fall to its side.” The book’s last poem, “The Firebird,” suggests that words, especially poems, might hold truths that sound louder than the approach of death: “The bell ringing in your throat will drown / out the train’s slow grieving” (p.67). 

These poems are beautifully crafted, often primal, and they touch the deepest reaches of personal illness and the shadow of mortality. Readers who have breast cancer or who have family or friends living with breast cancer, might find these poems difficult to read–others under the same circumstances might find them difficult and yet, at the same time, essential. For me, dealing with the reality of an aggressive breast cancer afflicting someone I love, these poems provide a window into an experience I can only observe from a distance, even if that distance is only an embrace away. These poems provide a portal into the emotions, fears, regrets, and pleas that might be hiding behind a patient’s or a loved one’s exterior of cheerful optimism and determination. We can’t walk the path that a woman with advanced breast cancer is traveling. But these poems help us be companions on the way. 

Miscellaneous 
“Strawberries in Snow” was first published in the Bellevue Literary Review (V12N1).  

Publisher Louisiana State University Press 
Place Published Baton Rouge 
Edition 2014 
Page Count 73 

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

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 

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

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. 

Rearranged by Kathleen Watt is subtitled “An Opera Singer’s Facial Cancer and Life Tranposed.”  At the outset of the book, the author feels on top of the world.  She can hardly believe she has the opportunity, as a member of the Metropolitan Opera Extra Chorus, to share the stage with some of her biggest idols.  She has a wonderful partner and a warm and close family. 

Then, one day, Watt discovers a bump in her mouth.  She is found to have a rare and aggressive oral cancer that is “breathtakingly tailored to obliterate my profession and my raison d’être, never mind my face” (p. 51).  She undergoes multiple reconstructive surgeries, some of which are unsuccessful or become infected.   While she is initially reassured she will be able to sing again in a few months, that goal proves unrealistic.  Watt’s partner is emotionally supportive for years, but even for her there is a limit.  When the author is unable to pull her own weight financially and develops an addiction to alcohol, the relationship unravels. 

The greater part of Rearranged chronicles Watt’s medical ordeals. Previously an active and productive person, she is now at the whim of her doctors’ schedules.  She gives up all hope of performing again. As anyone who has experienced an illness or the illness of a loved one knows, navigating the health care system can easily become a full-time job.   

The book ends optimistically as Watt’s condition stabilizes. She realizes she is lucky to be alive and accepts her “rearranged” looks.  She reconciles herself to a future where she will “henceforth sing mostly for myself “(p. 304), and redefines herself as a writer specializing in the performing arts. 

Rearranged is a book which teaches valuable lessons.  Watt endures extreme hardship, has her dreams shattered, and acquires wisdom that will benefit providers and patients.    

One lesson learned is that unempathic caregivers may compound a patient’s suffering.  “A multi-gigging freelancer with catastrophic coverage at best” (p. 31), the author has a miscommunication with an endodontist and is threatened with a lawsuit for presumed nonpayment.   And when she dares to question another doctor, he snaps at her: “Ha, ha!  I’m not going to teach you surgery” (p. 57).  Fortunately, other providers have a manner that is more conducive to healing: “Because he [the doctor] conveyed neither arrogance nor impatience, his confident command allowed me to trust him easily.  And at that moment, nothing mattered more to my successful outcome” (p. 55), and “Alone among my doctors, he had thought to lament my loss.  A helium cloud filled me at this simple expression of kindness.  Nothing at that moment could have been more restorative” (p.108).    

One can understand how traumatic it must be to have one’s facial features distorted as the result of illness.  For a singer it can be career-ending, not only because she needs to show her face to the public but because the vocal cavity may be damaged.  But, beyond this, because “the face is the single most important organ of human communication” (p.105), the author feels she has lost her identity: “I felt as bereft of myself as I was of my voice…I missed seeing my reflection in the faces of others.  I began to lose track of my own subtexts, and myself” (p.237)    

The author relates a vivid and frightening memory of experiencing post-operative delirium (sometimes called ICU psychosis). When she comes out of surgery and suddenly realizes she cannot talk because she has had a tracheotomy, she pounds on the wall.  She wishes she had had “healthy people to paste accurate information alongside my cockeyed perception, so I could avoid drawing mistaken conclusions from my misperceptions” (p.146).  Instead, she overhears attendants saying “Boy, she’s really out of it” (p. 149) and referring to her as “a royal bitch” (p.140).  At no time does anyone think to help “confirm her sanity, quell her fears” (p. 150).  Hopefully, health care professionals will read this and think about it the next time they see a patient right out of the OR.    

In closing, it bears mentioning that at one point Kathleen Watt consults with surgeon Iain Hutchison in London.  Hutchison is the initiator and sponsor of the Saving Faces Art Project, a series of paintings by artist Mark Gilbert which “portray the faces of patients before, after and in some cases actually during their surgery for injury, deformity or cancer” and whose purpose is to “communicate the strength of spirit which can enable people with facial disfigurements and trauma to lead full and happy lives.” (from https://savingfaces.co.uk/our-mission/art-project/ )  Likewise, the author of Rearranged inspires the reader by her strength of spirit in the face of inconceivable adversity. 

REARRANGED
An Opera Singer’s Facial Cancer And Life Transposed
Heliotrope Books, New York, 2023   
384 pages 

Kathleen Watt’s website: kathleenwatt.com

What could it be like to have dementia? We can’t know. But the arts can imagine what people with dementia could be going through, and many works have been produced for that purpose. We feature a literary novel (The Wilderness), and a play (The Father) and its movie adaptation, offering sophisticated renderings of dementia for consideration. In the course of our conversation about these works and how they imagine dementia, we include: how an illusionist was part of the creative team in The Father to produce a sense of disorientation among audience members; how the metaphor of “the wilderness” is used in the novel and more broadly in various texts from the beginning of civilization; and how well the psalm used in the novel worked and builds on the place of psalms as texts for understanding how people react when threatened by significant life events.

Featured Content Sources:
• The Wilderness, by Samantha Harvey, Anchor Books, 2009.
• The Father (play), Florian Zeller playwright, Doug Hughes director, Christopher Hampton translator, NYC Broadway 2016 + tour sites, London West End 2015 + tour sites.
• The Father (movie), Florian Zeller screenwriter and director, Christopher Hampton translator, Trademark Films, release date US – 2/26/21, available through many streaming services. 

Links:
Russell Teagarden’s associated blog pieces at According to the Arts: 
• The Wilderness: the novel and literary excerpts compared with biomedical text
• The Father: the play and the movie

Russell Teagarden’s review of The Father (movie) in the journal, The Pharos.
Podcast episode 6, which features dementia related to Parkinson’s disease and expressed through the poetry (sonnets) of Micheal O’Siadhail is here.
Background information on development of Alzheimer’s disease as an obscure and rare disease to a broad categorization of dementia: 
Claudia Chaufan, Brooke Hollister, Jennifer Nazareno, Patrick Fox. Medical ideology as a double-edged sword: The politics of cure and care in the making of Alzheimer’s disease. Soc Sci Med 2012;74:788-795.
Patrick Fox.  From Senility to Alzheimer’s Disease: The Rise of the Alzheimer’s Disease Movement. The Milbank Quarterly 1989; 67:58-102.

Feature image by Margarida CSilva

We examine excerpts from Siri Hustvedt’s novel, The Blindfold, and from Joan Didion’s essay, In Bed, for the perspectives they offer on what people experience when migraines strike them. We discuss how Hustvedt’s and Didion’s renderings of migraines add to classic biomedical descriptions, and consider the implications of migraine prevalence on the degree of suffering, functioning, and health care consumption. We muse about how these literary texts and others like them can be applied in helping people who suffer migraines and in helping people who care for them.

Bibliographic information:
The Blindfold, Siri Hustvedt, Picador, New York, 1992
In Bed: In The White Album, Joan Didion, Farrar, Straus and Giroux, New York, 1979

Additional background on the excerpts we cover, and excerpts from other books describing the effects of migraine are in Russell Teagarden’s blog, According to the Arts. An expanded analysis of the physical effects of migraine as depicted in The Blindfold can also be found on the blog here.

Some migraine prevalence data available from open-source publications are here and here.

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 Adrian Swancar