“I am we, we are a year, we year, we are rest, we rest.” 

In winter 2024, Sop had a severe relapse of myalgic encephalomyelitis, also called chronic fatigue syndrome (ME/CFS), leaving them housebound in South East London.

That summer, in the days leading up to a friend’s birthday celebration, the artist rested carefully so they would be able to attend. The night before, they started taking what was touted as a “magic” pill for insomnia. They didn’t sleep at all and had to miss the party. But in a sleep-deprived haze, they wrote, as they described in a recent interview [1], “a solidarity rant, a kind of letter to other disabled people stuck indoors.” 

When Shape Arts, a UK disability arts organization, approached Sop with a commission, they decided to adapt the essay into a script for We Year, a mixed-media love letter to others living with energy-limiting conditions. The short film premieres at RestFest—a film festival and virtual space by and for the disability community—as part of a program co-organized by The Remote Body, Resting Up Collective, and Ort Gallery. 

With a poetic voiceover and ethereal soundscape, We Year immerses viewers in a chronic illness flare during a sweltering summer, blending decades-old archival footage from when Sop was well enough to move outside freely with recent phone footage shot at home. Shifting between past and present and between interior and exterior, the experience is at once isolating and unifying, claustrophobic and liberating. 

We Year also features 16mm direct animation, a technique that involves drawing and scratching moving images directly onto film stock rather than recording with a camera. Here, Sop used ink to overlay the orange stress bars from their Garmin watch across the entire film—a constant representation of their body that acts as a symbolic barrier between them and the audience. 

The following interview has been edited for length and clarity. 

When did you begin to think of yourself as an artist? 

I always wanted to be an artist. Even as a kid, when I was asked, “What do you want to be?”, I was like, “An artist!” I honestly have never thought about doing anything else. I grew up in the deep countryside, and there wasn’t much access to contemporary culture, although I was obsessed with music and music magazines. There was this teen music magazine called Smash Hits that I loved, and I made collages and scrapbooks of pop stars. When I was 13, I went to a big retrospective of the massive British artist David Hockney, who just died, and it was the first time that I’d seen contemporary art. It blew my mind, and that’s the first time I remember thinking, “Oh, this is something serious that I want to do.” 

What questions or themes does your art usually explore? 

I find it hard to make work that isn’t about my life and the things that I’m dealing with. What I do always ends up being ultra-personal. That’s not something that a lot of people do, necessarily. The act of living as a chronically ill person means that you have to live in the world in a very different way from people who are not chronically ill. Chronic illness is a fertile area for ideas. You’re living the life and thinking about the life at the same time. If you’re an artist or someone who thinks about things in conceptual ways, you can’t help but try and interpret your life into art-making, projects, or ideas. Everything’s interesting. It’s like living life wonky.

As a chronically ill person,  I can’t do a 9 to 5. I can’t necessarily keep to plans, and I can’t always do basic things, like sometimes even look after myself in a normal  way. The agency that I have is to interrogate what this life means and the challenges that it poses and what is interesting about that. What can I say that’s beyond how I would perhaps describe being sick to a stranger? Like, what’s within that? All of the work that I make—even if it looks not about that—is going to be about that.   

And then the other part of it is that I grew up in the field and was a tomboy covered in mud. My understanding of the world was through nature, and now I’m in a flat without a garden. I can see some trees in the park just over there, but quite often, I’m not well enough to go and hang out in the park. I am pretty obsessed with nature and the fact that I can’t get to it. I can’t really have that life currently.  

In your bio, you describe yourself as “a torn and crooked leaf, a root embedded in the dirt, a shoot reaching to the sky.” Would you please elaborate on what this means? 

When I wrote that bio, I was making work about my body being the same as the microbiome in the soil. “A torn and crooked leaf” is being chronically ill. “A root embedded in the dirt” is really what it sounds like, within the context of that specific work. And the “shoot reaching to the sky”—my work deals with pretty hefty emotions, but there’s always hope. My life is not a miserable life; it is hopeful, and I do believe there’s something so crucial in being chronically ill that you absolutely have to keep hope alive. It takes a lot of work to do that and to get there. It’s not easy, but it’s super important. If you have this restricted life, you absolutely have to shoot for the sky. Because time just goes on.  

What does working in crip time [2] look like for you? What are your long-term goals as an artist? 

If you’re truly working in crip time, it’s fairly impossible to have long-term goals. You haven’t really got a choice when you work. You can do your very best to carve out time or space. Currently, I have about a couple of hours in the early morning when I can manage to do something. My afternoons and evenings—I simply can’t make work then. If you have such a limited time to make work, the amount of work you make is going to be low. It will have to meet your capacity, and that doesn’t fit well with current art market production timelines or expectations. Sometimes, you can’t make something for a year because the thing that you should be working on—and the thing that is your work—is your health. That’s your full-time job.  

I deeply believe that making in crip time actually is truthful to the world. We would probably all be better off if we did. Really, it means making work to your capacity, and that can mean a lot of things. You don’t need to be ill to make to your capacity. 

It’s a more authentic timeline of meeting yourself where you’re at, rather than forcing yourself to meet arbitrary or toxic timelines. 

You haven’t chosen to have chronic illness—you’re forced into doing that. And I don’t think that’s a bad thing necessarily. Asking what would I like to do for my long-term goals—I find it very hard to answer because, first of all, I live, like, day to day and, second, when I think about what my long-term goals would be, it’s from the perspective of someone without a disability because I currently cannot see how I would be able to do more than what I’m doing unless I had an enormous amount of more support. 

How did you decide which media to work with for this project? 

Films and writing have always been the two mediums I mostly turn to, and actually they’re the most accessible things for me to do now, being housebound. When I was asked to make the film, I just didn’t have it at all in my means to film new work or leave the house, so I had to kind of figure out how to make a new work out of what I had, which was this personal essay I wrote about being stuck inside in the summer. I made the film throughout another summer of being stuck inside. A lot of chronically ill people turn their camera or phone or whatever onto their surroundings, so I had bits and bobs that I filmed. When I started making films, I would just film tons of different stuff. I had my little Hi8 video camera around the whole time, so I had lots of little clips that I hadn’t used, and I didn’t actually think that I was ever going to use them for anything. But that obviously wasn’t enough, and I didn’t really want to make a film which was just a film inside my house—there’s plenty of films like that. I had a whole bunch of old footage from the 90s. I digitized all of these tapes a few years ago, and they looked so great. A lot of that stuff was filmed out of the house, and then there were funny effects that I filmed which made it into the films. There’s a lot of blobs of color, which are actually motorway lights and ended up being this really nice kind of texture, which floated over and broke up some of the images.  

Hi8 and MiniDVs are the two cameras I was using in the past, so I have footage from both of those. And then there was 16mm direct animation. Each section of the film has a different animation running over it, but the animation is quite transparent, so it’s always there. It’s textural and has multiple meanings. And then I commissioned my friend to make the soundtrack. 

Would you elaborate on the meaning of the title of the film? 

The thing that’s turned me on most about this film is the fact that I can try and get “to year” and “yearing” adopted as a new way of describing spending all this time being sick. I think the word “year” is long enough for people to imagine, “Whoa, you are sick for a whole year. That’s a really long, unbearable time.” But then you make it into “yearing,” and then it could be even less than a year, but it’s probably closer to a year or multiple years. Then I was interested in what would happen if the years were then broken up with periods of being well, with relapses included as well.  

I find it really tiresome to have to explain the last five years of my life. So to not have to say, “Well, I was sick for a couple of years, housebound and bedbound, and then I got well again, and then I had a relapse”—it’s just like, “I was yearing.” I would love for it to become part of the lexicon of chronic illness.  

What does it mean to have “We Year” screened at RestFest? 

There’s this informal network of crip friends who work with each other. Not everyone works together, but we all know each other and there’s really close friendships within this group. They’re all small, crip-led organizations that have been made pretty much for the same purpose, which is remote events, screenings, and workshops. I was just really keen to connect and uplift all of these organizations. We created this program together, and I’m really proud of it. It’s been a lot of work, but it’s really nice making things with your friends. The access intimacy side of it all is real. Creating or programming with your friends is a very accessible way of making because we all understand each other and our capacities. I’ve said capacities a million times. 

You need to coin a new term for that as well. 

Okay, I’ll get on that for next time. 

We Year, through July 12 (if you start watching on June 28); RestFest Film Festival. “I am we, we are a year, we year, we are rest, we rest.” 

[1] “Interview with artist-filmmaker Sop + a Special Screening of their New Film.” RestFest, 2026,
https://restfest.substack.com/p/interview-with-artist-filmmaker-sop. 
[2] In her 2013 book Feminist, Queer, Crip, disability scholar Alison Kafer writes, “Rather than bend disabled bodies and minds to meet the clock, crip time bends the clock to meet disabled bodies and minds.” 

I am glad to report that Playground is a success on this count. In this most recent novel, Powers turns to the ocean as a backdrop for his story. He weaves together the narratives of three main characters. Todd Keane, who is the son of a successful businessman, grows up privileged in upper-crust Chicago. As a high school student in a top-tier private school in the 1970s, he is captivated by the relatively crude computers of the time, mounts the technology wave and feverishly rides it to professional success as an adult. Evie Beaulieu is literally and figuratively thrown into the water at a young age by her father, a deep sea explorer, and becomes obsessed with everything watery. She is more comfortable swimming deep beneath the ocean surface than walking on land. With the support of a gentle and self-effacing husband, she becomes a world famous oceanographer who achieves renown because of her ability to convey the magic and mystery of the ocean equally well to her scientific colleagues and young adult readers, echoes of Richard Powers himself. Finally, Ina Aroita grew up on the Pacific island, Makatea, but moved to the United States to pursue studies in the creative arts and becomes a sculptor. In college, she meets Todd and through him she is introduced to an important fourth character, Rafi Young, who pulls together the Keane-Aroita story lines.

Rafi grew up in the Black neighborhoods of South Side Chicago. He is a voracious reader from the first day of school and, defying the odds,  wins a scholarship to attend the same high school as Todd Keane. They meet over intense games of chess, advance to the ancient addictive game of Go, and develop a powerful but vulnerable friendship. They both choose to go to college at the University of Illinois, and Ina is drawn into their orbit.  Powers pulls all of these characters into a tight web that centers on the ambitious plan of an American company  to build a self-sustaining city that will launched from Makatea and will be submerged under the surface of the water. The residents of the island are being asked to weigh the pros and cons of the “seasteading” initiative and decide whether to approve it. The rationale offered by the proponents is that life in such a unique environment will enable the occupants of the submerged city to live in a realm outside the jurisdiction of any company and be free to pursue their intellectual pursuits and dreams about expanding the use of artificial intelligence, free of government interference and restrictions.

Extreme libertarianism meets AI wonderland.

Powers populates his literary world with characters we come to know well and grow attached to. It is a strength of Playground that they are believable and not simply spokespeople for a point of view. Powers explores many themes in this book. Games, those that people play casually for leisure, like chess, and those that they play intensely for success in life figure prominently in the novel. Todd and Rafi’s obsession with the ancient board game of Go, with its infinite number of possible outcomes branching out from a simple 19×19 linear grid, becomes an incubator for their ideas about computing capacity. Go provides an alluring framework to explore human behavior and model it for use by programmers of life-like computer surrogates. The game provides the initial inspiration for Todd to design powerful AI systems that can mimic humans and beat them at their own games. There is an appreciation of the growing potential for unpredictable outcomes as computer systems become more complex, machine learning diversifies, and neural networks become denser. The example that most impresses Keane (and Powers) involves the game of AlphaGo, an actual computer program, which was designed to play Go at championship level. Todd recounts his feelings of awe when the program  made an inexplicable move in a game against Ke Jie, the number one ranked player in the world at the time, that sealed the computer’s victory in a three-game match. This was something that was thought to be beyond the power of any computer (this same episode features prominently in the book Maniac by Benjamin Labatut).

In this novel, the inventiveness of nature and the unpredictability of human interactions far surpasses anything that AI accomplishes. The complexity of the natural world, its wondrous diversity, its unexpected vitality, is captured in incandescent prose as Powers describes the glowing colors of the deep-sea creatures. Can and will computers achieve a sense of stewardship and legacy? Will they develop an attachment to the environment around them and struggle to sustain it and pass it on whole to the next generation of computers in the same way that links people across and with future generations?

The novel reaches a climax and the ending involves an unexpected plot twist. The book is too much of a fun read for me to reveal it and spoil it for you. One hint — keep in mind that Todd Keane is an extraordinarily complex person. That said, what is striking is how marginally AI actually influences the actual outcome of the novel. It is more of a gadget play than an active player in the narrative. It is as if Powers himself is unsure how AI will impact those of us alive today and the generations that will come after us. If this is true for Powers, then it suggests that all of us should stay modest in our predictions of the future of AI. Reading Playground, I think he would remind us to keep in mind that however things turn out with AI, it will probably work out best if we remember the grandeur of nature and the human capacity to care deeply for one another and our environment, qualities that Powers describes with an expansive intelligence and poetic beauty.

Playground
Richard Powers
W. W. Norton & Co.2024.
381 pp (paperback)

Web image by Medhum.org

In “Mandatory Evacuation Zone,” Felice Aull has gathered 63 beautifully crafted poems in which she examines the intricacies of language and loss, of grief and healing.  Each of the book’s five sections considers these themes in slightly different ways, always in language that is understated, vivid, and exact.  In Section I, we read poems that focus on the author’s complicated family history and her early loss of homeland.  In “Tracings” (page 15), an unknown relative (thanks to online genealogy searches) reaches the narrator and wants to meet her.  She, however, only wishes to learn “. . . how my parents / and my infant self / made our tortuous way out . . . . ” Brought in infancy from Germany to America, the author suffers the loss of both native homeland and native language (“Notes from an Alpine Vacation” page 16).  She searches photos of her mother and ponders museum note cards illustrated by Holocaust survivors (“Museum Notecards” page 18), imagining what she can’t quite know and yet can’t quite forget.  

Section II finds the narrator as a young woman in American, awakening to sexuality (“Gay Blades,” “Camp Counselors Make Out,”  “On the Staircase” pages 29-31), becoming a wife and mother, and then a grandmother.  A grandchild’s birth is both joyful and yet another “slipping toward / the edge of separation” (“Daughter in her Eighth Month” page 37). 

In Section III, the author turns her gaze to observations of the world around her, around us, aware of how many come to loss and death.  “Be prepare to mourn,” she tells us in “Disaster in October” (page 49), and in the moving poem, “I Saw the Smoke,” re-visions September 11th in words stripped of sentimentality and therefore made more powerful. 

Sections IV and V confront bodily loss through aging and illness, noting how, in so many ways, we try both to capture and to let go: “You snap photo upon photo / hoping to grasp and preserve / what cannot be grasped” (Capturing Alaska” page 66).  We learn of the most personal losses in poems of biopsies, surgeries, and chemotherapy.  When facing the unknown, every event might seem to hold a prediction.  In “Stunning Blows,” a doorman stuns a mouse, claims that it’s dead.  But the narrator, aware of the wages of time, writes, “But I still see it, like death, / moving toward me” (page 81).  At the book’s end, we return to language, how it too can leave us (“Forget That” page 90).  Yet in the collection’s final, gentle poems, the poet is “able, finally / to walk past the park’s redbud tree / without weeping” (“Immunity” page 96).

Although there are many poems that confront loss both recalled and experienced. grief for self and others, illness and the unknown in this collection, there are also poems of great acceptance and ultimate joy: “These gifts and losses, every year, mine” (“The Key to Gramercy Park” page 98).  The poems in “Mandatory Evacuation Zone,” show us how poetry can help us to “declutter” (see “Divesture” page 99) and release, and at the same time, hold on to and embrace.

Kelsay Books, California 2017: 100 pages

Felice’s website: https://www.feliceaull.com/

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

Egon devotedly cares for his sick wife despite her warning, “You will get it from me” (p111). Soon she is unresponsive. As Egon listens for a heartbeat with his ear against Edi’s motionless chest, he can only auscultate the distant, faint beat of his unborn child’s heart that is quickly silent. He tragically describes Edi’s corpse: “Her body being both cradle and coffin, within a minute” (p128). Egon feels compelled to make multiple sketches of his dead wife. 

Before long, Egon experiences harsh bouts of coughing, fever, and chills. He becomes remorseful about the drawings he made of Edi and burns them in the kitchen stove. Egon gazes at the fire, knowing he too will die shortly but aware that he will be survived by all his other artwork. 

This short story imagines the final days of Austrian painter Egon Schiele and his pregnant wife Edith. He died at age 28, just three days after she passed away, both victims of the 1918 influenza pandemic. 

A stunning and sorrowful re-creation of what the end of life might have felt like for a young husband and his expectant wife during the 1918 pandemic. The tale highlights the risk of love, the inescapable weight of dread, and the connection between creativity and illness. 

Primary Source 
Blank Pages and Other Stories (pp105-138) 

Publisher 
W.W. Norton & Company, New York, 2022: 34 pages 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is one thing to read about bipolar disorder in a textbook, and another thing to observe it firsthand. Some of us have friends or family members whom we have seen in the throes of a manic episode. As a psychiatrist, I have witnessed mania at close range literally hundreds of times. But to be an audience member and to experience it in a way that manages to be both educational and entertaining is a rare privilege. And to do so as a multimedia event, fusing theater with visual arts, is surely unique.  

Sam Kissajukian’s one-man show 300 Paintings is a must-see that is currently enjoying a return engagement at the Vineyard Theatre in New York. (It is purely a coincidence that the theater, just off Union Square, is a block away from my former psychiatric office of eighteen years.)  

Kissajukian is an Australian stand-up comic. In 2021, during the pandemic, he experienced a five-month bipolar manic episode. During that time, despite having no previous background in visual arts, he decided to become a painter. Moving into a warehouse, he began to paint. He barely slept, frequently turning out multiple works a day. By the end of the episode he had created three hundred paintings, documenting his mental state.  

Kinssajukian has created the show he calls 300 Paintings as the culmination of his personal and artistic journey. The show has won numerous awards, including Best Comedy at Sydney Fringe 2022 and 2023, and the Mental Health Awareness Award at Adelaide Fringe 2024. It has played at the Edinburgh Fringe Festival, and it first came to the Vineyard last fall. He has also had several exhibitions of his paintings, and has come out as a strong advocate for mental health awareness. 

While 300 Paintings calls on the author’s experience as a comic, it is no mere stand-up routine. At 80 minutes it has the dimension and scope of a play. There are serious undertones, yet there are many undoubtedly funny parts: We hear how at his most grandiose Kinssajukian thinks of himself as a “Pisscasso” who goes through a blue period in days, rather than years. At another point he describes how he affected a beret. Funny or serious, he is always charming and engaging, and he breaks it up by showing projections of his work.  

There are times when the dialogue takes on the rapid, pressured speech of a person who is manic, and his thought process shows the jumping from topic to topic that a psychiatrist refers to as “flight of ideas,” But this feels intentional. At no time do you worry that the performer does not have it under control. And he readily attributes this to his rapid diagnosis and treatment by a psychiatrist.  

At the end of the performance, Kissajukian announces that a curated exhibition of his paintings is on view in the lobby, and that he will be available to meet the audience.  

Two Paintings by Kissajukian

Podcast

Web image provided by Sam Kissajukian

What makes The Magician so unique as a novel is its depiction of writing as an all-encompassing creative activity that consumes the author’s full psychic energy and that emerges out of his personal struggles as an individual. It would be impossible to affix The Magician to the back cover of all editions of Buddenbrooks or The Magic Mountain. Tóibín offers more than a page of scholarly references to help a reader gain background knowledge about Mann, his life, and the times. But if you are interested in what it might have been like for Thomas Mann to compose these monumental works, Tóibín’s book might offer the best entry point into Mann’s artistic mind and his creative persona.  

The novel covers the full panorama of Mann’s life, from his somewhat pampered childhood in Lübeck, Germany, to his final years spent in the German expatriate community of Los Angeles. The writer’s camera is laser focused on ground level details and refuses to zoom out to the big picture and lose its granular tone. The texture of the bourgeois lifestyle of the Mann family is captured in all its minutia including rowdy family meals, community engagements, and professional insults. One can almost feel the temperature rise and the climate change as Mann and his family move from Munich to Princeton and finally to Pacific Palisades. Mann exerted very tight control over his daily routine and one senses his absence on the page as he withdraws to his private study every morning after breakfast to write without any interruptions. We are excluded from this sanctuary just like his wife and children as they waited for him to emerge after lunch for his afternoon walk and some playtime with them.

Mann was more than a prominent novelist. He was a winner of the Nobel Prize in Literature in 1929, globally recognized and one of the most famous personalities of his time. He hobnobbed with dignitaries and the leading figures of the pre-World War II era, including Einstein and FDR. They parade across the pages of the novel with all their foibles and idiosyncrasies. Tóibín details Mann’s tempestuous relationship with Agnes Meyer, a leading figure in high society along the New York-Washington DC corridor. I had to look her up to learn that she was a well-known journalist and civil right activist and Katherine Graham’s mother to appreciate her impact on the world during the 1930s and 40s. 

The most striking feature of the book is the intimate recounting of Mann’s tortured struggles with his sexual orientation, which infiltrated his fiction from the very beginning of his career. He never denied his homoerotic longings and Tóibín delicately describes the many occasions during his long life when Mann was overwhelmed with desire for a particular man and his secretive attempts to act on his cravings. But he was a man of his era and was forced to submerge his identity as a gay man most of the time. The emotional cost of a life lived closeted on the one hand, and as the married father of six children on the other, is readily apparent. Reading The Magician motivated me to reread Death in Venice and made me realize the courage it must have taken for Mann to portray Aschenbach’s tragic story in such complex but precise prose, to reify his own emotional turmoil without sanctimony or defensiveness. Tóibín’s prose is the ideal conduit to channel the roiling interface between the Mann of the larger world and the inner literary mind of a flesh and bones historical human being. 

The Magician is an engrossing reading experience that also has special salience for followers of the MedHum website, which explores the role of the individual in a changing society. A key element that drives the narrative forward is Mann’s engagement with the political developments in Germany over the long period spanning from the lead-in to World War I, to the outbreak of hostilities in August 1914 and again in September 1939 and the devastating war years, and ending with the rebuilding of his native country. At the start, Mann saw himself as heir to a tradition of German intellectual excellence and nobility. He took great pride in his country and patriotically defended the decision to go to war against France, Britain, and Russia in August 1914. However, he recognized the dangers posed by the Nazi seizure of power and openly decried the degradation of public life. Mann felt the Nazi destruction of the German cultural heritage as a personal betrayal. Mann recognized early on the brutality of the antisemitic legislation and the attacks on his Jewish colleagues. He was forced to weigh loyalty to country against the defense of universal humanistic principles and he struggled to find a path forward between these competing ideals.  

As Hitler rose to power, were Mann’s instincts right that this would bring calamity to Germany, or should he have had trust in his fellow citizens that things would right themselves? How much could Mann rely on his interpretation of unfolding political events and his prediction of what the future would look like? Once the Nazis consolidated their dictatorial control of the Reich and set out on a course for total war and extermination of the Jews, should Mann have been a strident and outspoken opponent of the regime or should he have worked more discreetly behind the scenes? Should he have remained in Germany and risked his own life and the safety of his family, especially his wife’s Jewish relatives, or sought refuge in America, where he could serve as a champion of cultural enlightenment and world peace? How does one weigh the facts and decide on an effective course of moral action? How does one choose among imperfect options? 

Like all of us, Mann was forced to anticipate events and make painful decisions—decisions that would play out over time and have consequences for others– in real time and with only partial or inaccurate data. Much like the case with physicians and other health care professionals, most of these decisions will work out well, some will be imperfect, and a few will even be wrong. Tóibín’s novel, history as fiction, vividly illustrates the human predicament of living while moving forward with uncertainty and anxiety because full clarity only comes in retrospect — something that doctors understand because they experience it nearly every day in encounters with their patients.  

The Magician – Reading by Colm Tóibín & Conversation with Friedhelm Marx at the Thomas Mann House 

The Magician: A Novel 
Colm Tóibín 
New York: Scribner, 2021, 512 pages  

Photo of Thomas Mann generated from Wikicommon Photos

Cyrus aspires to be a poet but is drowning in self-pity and drug use. He wants more than anything to achieve renown and martyrdom and to die after having made a lasting mark in the world. Interwoven with these tragic human circumstances are antic elements that collide with this depressing narrative. The novel opens abruptly with a humorous but disconcerting encounter between Cyrus, who is working as a surrogate patient in an introduction to medicine class, and a student, who is clearly in the early stages of her education. Cyrus is having a bad day and cynically takes on the role of the difficult patient, nearly driving the student to tears. There is a zany episode when Cyrus and a friend take on a home maintenance and wood chopping job for a man who lives alone and who monitors their work wearing only his underwear.  

Dream sequences in which Cyrus receives guidance from figures ranging from Kareem Abdul Jabbar to a thinly disguised, now President Trump materialize without warning. An uncle, his mother’s older brother, passes through the story several times appearing as a figure draped in a black hooded cape and riding on horseback across the blood-drenched Iran-Iraq war battlefields. His mission is to reassure the dying soldiers that they will ascend to paradise. Yet, despite these disparate elements, the book has a powerful coherence and momentum. One of the most striking features of the book is its extraordinarily imaginative similes– “he was skinny in a scrawny way, not like a runner but like a mathematician who forgets to eat,” “the middle school teacher… offered him a racial slur, like a juicy orange they might peel together and share.” These phrases demand that you slow down the pace of your reading and take note of the author’s creativity.  

Engagement with language and its communicative limitations emerges as a key theme of Martyr!. Cyrus comments frequently on the arbitrariness of language and the terrifying consequences that can arise from the words we use. Akbar embeds this idea in his writing by implying that plain words alone are inadequate to capture the essence of things, and the only reliable way to convey meaning to readers is by creating vivid and arresting comparisons. The plot of the book takes off when Cyrus is encouraged by a friend to go to the Brooklyn Museum and visit a featured exhibit, DEATH-SPEAK. It consists of an artist who is dying of cancer sitting on a chair and talking with the visitors about death during the final weeks of her life. An unanticipated bond is quickly established between the artist named Orkideh and Cyrus. He feels compelled to return and speak with her over the next four days. Their conversation is genuine and moving. There is more to the artist and her art than meets Cyrus’ eye, and those unexpected twists drive the story to its blazing finish.  

What is one to make of this wholly original and emotionally charged novel? I will restrict myself to three thoughts that have had staying power after finishing the book a month ago. First, as mentioned above, Martyr! raises provocative questions about the limitations of language and our ability to communicate with one another. Cyrus (and Akbar) questions the capacity of words alone to express meaning, as if each of us has our own private language. If we can firmly ground our language with references to concrete, real life experiences, which is precisely what Akbar does with the beautiful and jarring similes that are interwoven into the entire book, then we may be able to convey meaning. That Akbar can introduce such a recondite idea, a variant of playing language games, into a best-selling novel is a feat worth noting.  

Second, there is a yearning to be healed that drives Cyrus’ quest. Martyrdom is the outer expression, but it is a quest for meaning that is the true driving force that motivates Cyrus to take healthy action in the novel. He attends a group therapy program and has a tough-minded supervisor to help him detox from his drug use. Ultimately, it is the new awareness that Cyrus gains about his parents that enables him to achieve psychological equanimity and peace of mind.  

Finally, what is the martyrdom that Cyrus longs for? He is not looking to wrap himself with explosives, kill the infidels, and gain entry to paradise. One could say that what he so desperately wants is lasting fame and renown for an act or artistic creation that will be seen as unique and cherished, that will survive after him, and that will keep his name eternally alive. The Book of Martyrs, a fictional collection of poems written by Cyrus that are interspersed in the text, could conceivably represent this hoped-for act of martyrdom. However, the ending of the novel suggests that Akbar may have a less explosive and more intimate notion of what martyrdom means. The knowledge that Cyrus gains over the course of the novel and his interactions with Orkideh spur him to finally achieve the martyrdom he seeks. His ultimate fate on the final page is actually a bit murky. But the vision that one is left with is that Cyrus has indeed achieved a life of meaning because it is a life of meaningful interpersonal connections.  

Martyr! 
Kaveh Akbar 
Alfred A. Knopf, 2024, pp 332 
Web image by Levi Meir Clancy

“At once it struck me what quality went to form a Man of Achievement, especially in Literature, and which Shakespeare possessed so enormously — I mean Negative Capability, that is, when a man is capable of being in uncertainties, mysteries, doubts, without any irritable searching after fact and reason.”¹ 

The young physician then went on to cite Samuel Taylor Coleridge as a poet whom he considered deficient in negative capability because he was “incapable of remaining content with half-knowledge.”¹ What exactly did Keats mean? That Coleridge was too curious or too intellectual to be a great poet? We’ll never know because Keats, who died of tuberculosis less than four years later, never referred to negative capability again, either in his letters or other writings.  

A single mention in a private letter is not much of a pedigree. Nonetheless, Keats’ casual turn of phrase has generated plenty of writings by others in the centuries that followed. Literary critics generally interpret negative capability to mean being open to the world without having preconceived theories, a willingness to suspend judgment, and/or the ability to function imaginatively in the face of incomplete knowledge (e.g. uncertainties, mysteries). In recent decades notable psychoanalysts and philosophers have championed the importance of negative capability in their own fields. In fact, with the enthusiasm of a dilettante who knows little about literary criticism, I’ve gone so far as to argue that negative capability is an important quality for clinicians to develop.²  

Wait a second! There’s something wrong with this picture. Physicians not “searching after fact and reason”? Doctors “remaining content with half-knowledge”? How can negative capability be a positive quality in scientific medicine? It sounds negative for sure, but not very capable.  

What did John Keats have in mind when he invented the term? In 1816 he had successfully passed his examination for a medical license and joined the Worshipful Society of Apothecaries, yet had also become increasingly ambivalent about a career in medicine. By late 1817 he and his brothers had rented a house in Hampstead, where John devoted himself to writing poetry, as well as taking care of Tom, who was dying of tuberculosis. Keats had given up the idea of practicing medicine. Yet could medical training have had any influence on his concept of negative capability?  

Medicine has a long tradition that attributes a special quality to the diagnostic and therapeutic thought processes of good clinicians, an attribute independent of intelligence, medical knowledge, or even logical deduction—with all due respect to Sir Arthur Conan Doyle and his teacher, Dr. Joseph Bell, who served as the model for Sherlock Holmes. When I was a medical student, my teachers referred to this quality as clinical intuition or clinical judgment. Yet the word “intuition” was always suspect because it smacked of mysticism, and “judgment” was co-opted in the 1970s by clinical epidemiologists, like Alvan Feinstein, who characterized it in mathematical terms of probability and utility, which sounded good but didn’t capture the experiential quality of medical thinking.³  

In an episode of “Star Trek,” when Spock questions Captain Kirk about an apparently foolhardy decision that has endangered the entire crew of the USS Enterprise, Kirk replies, “It’s not logical. It doesn’t make sense. It’s my gut feeling!” Kirk, as usual, had chosen the right course of action and by the end of the episode saves the day. However, even if clinical judgment can’t be reduced to an algorithm, surely it must have more going for it than gut feelings. I recently found an interesting, and I think plausible, definition in the nursing literature: “a judgment in which visual and verbal cues are so rapidly and subliminally observed that their contributions to the final decision are virtually forgotten.”⁴ 

Yet visual and verbal cues can’t stand alone. They require something to integrate them, a process, a creative spin. Some years ago Edward de Bono coined the term “lateral thinking” for an indirect approach to problem solving, involving ideas that might not be obtainable by using traditional step-by-step logic. (Parenthetically, I imagine that for de Bono the more traditional approach to problem solving must logically be entitled “medial thinking, i.e. closer to the center, whatever that means.) De Bono’s lateral thinking seems roughly equivalent to today’s favorite metaphor for creativity, “thinking outside the box.” Alternatively, those of us who slavishly adhere to reason are doomed to remain trapped inside the box, like Schrödinger’s cat, neither dead nor alive.  

Whatever you call it, I find something attractive about attributing a special openness and curiosity to the art of medicine, an openness that permits a greater variety of information to enter the box, rather than kicking the logical brain out of it. In his famous turn of phrase, Keats obviously chose to give “negative” a beneficial meaning. Negative in this context implies passivity, receptivity, and humility , yet it seems these qualities are precisely what made the difference between a competent poet like Coleridge and a truly creative one. Does this sense of negativity have a place in the art of medicine? Does it tell us anything about the difference between merely competent and master clinicians?  

One aspect of the comparison fails immediately. Unlike Keats, whose primary goal was beauty, physicians are heavily invested in truth. So “searching after fact and reason” is the name of the game in medicine, not the road to mediocrity. But other aspects of negative capability seem more promising. What if you view negative capability as intellectual and emotional openness, a willingness to be reflective and mindful about one’s practice? While “reaching after fact and reason” may be a defining feature of scientific medicine, clinicians confront a human reality that remains opaque, even after machines and lab tests have yielded their results. If we as clinicians predicate our care entirely on “irritable reaching,” or abandon patients because of “uncertainties, mysteries, doubts,” we lose much of our effectiveness as healers.  

Of course, poetry is only one of many tools that can assist us in developing the habit of reflectiveness, but for me it offers a glimpse into the paradox of the art of medicine: the ability to function at the interface between detachment and engagement, steadiness and tenderness, resilience and vulnerability, science and art. In pursuing the steadiness and detachment required to master clinical practice, it is tempting to neglect the more difficult project of nourishing engagement and tenderness in our relationships with patients—and with ourselves. In an address to medical students at McGill University, William Osler claimed,  

“Nothing will sustain you more potently in your humdrum routine… than the power to recognize the true poetry of life—the poetry of the commonplace, of the ordinary man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs.”⁵  

That “power to recognize the true poetry of life” is a function of negative capability. Notice that Osler speaks of sustaining the physician through the “humdrum routine” of professional life, not specifically of patient benefit. Could it be that physicians who develop negative capability are happier, more productive, less likely to burn-out? 

I’ll end with an example close to home. In my narrative medicine elective at Stony Brook, I used to ask students to keep a clinical journal. In one of her final entries, one fourth year student, reflecting on her experience in medical school, wrote, “The practice of medicine is simply poetry in motion. The art of medicine is the validation of everything that makes the human experience. I learned more about myself than I ever imagined….”  

Simply poetry in motion.  

I wonder what John Keats, who rejected medicine for poetry, would have to say about that?  

References

1. Keats J. The Complete Poetical Works and Letters of John Keats, Cambridge Edition. Houghton, Mifflin and Company, 1899, p. 277. 
2. Coulehan J, Clary P. Healing the healer: Poetry in Palliative Care, J Palliative Medicine, 2005; 8: 382-389. 
3. Feinstein A. Clinical Judgment. Baltimore, Williams & Wilkins, 1967. 
4. Cioffi J. Heuristics, servants to intuition, in clinical decision-making. J Adv Nurs 1997; 26: 203-8. 
5. Osler W. The student life. In Osler’s ‘A Way of Life’ & Other Addresses With Commentary & Annotations, eds. S Hinohara and H Niki, Durham, Duke University Press, 2001, pp. 305-330.  
   

Web image from Keats Letter Project.