Daudet tried all sorts of therapy, including mashed bulls’ testicles and elixir of guinea pig. Nothing worked, with the exception of large quantities of morphine and chloral hydrate, which made his life bearable. Daudet also coped with his intractable pain by writing about it. He planned to write a complete memoir of his life with pain, but by the time of his death in 1897, he hadn’t gotten farther than 60-odd pages of notes and reflections. About twenty-five years ago, the English author Julian Barnes translated and collected these fragments into a small jewel of a book called In the Land of Pain.¹

The title is illustrative. Those who suffer from chronic pain live in a different country from the healthy, and they gradually find themselves speaking a language that others don’t understand. At first, Daudet introduces details of his discomfort into conversation but soon realizes how repetitive and boring this is to his friends. “Pain is always new to the sufferer,” he writes, “but loses its originality for those around him. Everyone will get used to it, except me.” (p. 19) Daudet finds himself living in a land where suffering is pervasive, “Pain finds its way everywhere, into my vision, my feelings, my sense of judgment; it’s an infiltration.” (p.23) Toward the end he writes, “I’ve passed the stage where illness brings any advantage or helps you understand things; also, the stage where it sours your life, puts a harshness in your voice, makes every cogwheel shriek.” (p. 65)

Although Daudet was not known as a poet, many of these presumably random notes are, in fact, miniature poems. Consider this example: “In the dining room: the man who quite suddenly finds himself unable to read the menu. His wife bursts into tears and leaves the table…” (p. 63) And here is another: “The hotel. The bell-board. The bath times. / Solitude. / Encroaching darkness.” (p. 65)

One of the more depressing aspects of medicine today is the fact that many doctors are still “very poor at discerning things,” at least when it comes to pain. I get a knot in the pit of my stomach whenever I hear a resident discussing whether a patient’s pain is “real” or “imaginary,” or making a cynical comment about drug seeking behavior, especially when the resident herself has prescribed a grossly inadequate course of analgesia. Some of my colleagues believe that a person has to be visibly anguished before they take seriously his reported experience of severe pain. And others get exasperated with patients who describe having more pain than their condition (according to the doctor) warrants, and tell them, “You’re overreacting,” or “It’s all in your head.” When I hear this, I want to shake the physician by their shoulders and yell, “Of course it is! All pain, no matter what causes it, exists in the head. Where else could the experience be generated?”

In the Land of Pain illustrates that chronic pain sufferers can live calm, productive lives despite constant agony. Daudet continued writing, publishing, and socializing until the end of his life, even though he wrote, near the beginning of his journal, “My friends, the ship is sinking, I’m going down, holed below the water line.” (p.7) At the same time, the author’s strength, compassion, and humor illuminate his little book. He emerges as a generous person, who was well loved by his contemporaries. If you were his physician, what would your assessment be?

Would you accuse him of exaggerating his pain because he doesn’t appear desperate?

Daudet refers to his pain as an “unwanted guest,” to whom he intends to give “no special attention.” (p. 79) At another point he reflects on “the ingenious efforts a disease makes in order to survive.” (p. 26) The writer never questions his enemy’s ultimate victory, but neither does he turn in upon himself. He remains a source of joy to others, especially his family, as indicated in this note: “I only know one thing, and that is to shout to my children, ‘Long live life!’ But it’s hard to do so while I am ripped apart by pain.” (p.49)

Chronic pain remains challenging for doctors to treat. One set of barriers are the moral and legal concerns about overuse of opioid analgesics. Questions about the threat of addiction, or the possibility of being manipulated, favor resisting the patient’s suffering, rather than responding with compassion. Many are uncertain about how to proceed because they lack knowledge of treatment protocols that include nonpharmacologic modalities, or referral to pain control clinics for invasive procedures. Alphonse Daudet’s little book invites us to imagine ourselves living, at least for a little while, in the land of pain.

1. Daudet A. In the Land of Pain. Edited and translated by Julian Barnes. New York, Alfred K. Knopf, 2002. (page numbers indicated in the text).

Photo of Alphonse Daudet from Wikicommons.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Maintaining our resource-rich website. 

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

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

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

BREATHE TRAILER: 

VIEW THE FILM HERE: 

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

The Secularization of Medicine: Ritual, Salvation, and Prophecy by Nathan Carlin 

New York, NY: Oxford University Press, 2025, 264 pages 
ISBN 9780197574003 

Once upon a time, religion and medicine were quite close. Even now, parallels between the two are notable. Churches often have a spire pointing towards heaven. Modern medical centers are increasingly towering structures that reach to the sky. Churches have an altar, and hospitals contain operating tables. Clerics don distinctive vestments. Doctors have their own traditional attire – a white lab coat or scrub suit. Hearing a confession (whether in a hushed booth or a clinic exam room) is integral to both vocations. Some churches have holy water fonts for spiritual cleansing. Physician offices have readily available hand sanitizer. Carlin (an ordained Presbyterian minister and the Director of the McGovern Center for Humanities and Ethics at UTHealth Houston) explores the relationship between medicine and religion by focusing on secularization theory and the idea of transposition. His aim is to provide “a more critical understanding of the rituals, myths, and stories of and in medicine” (p20). In the book’s best section titled “Ritual,” the Hippocratic Oath (which invokes Greek gods) and the purpose of the White Coat Ceremony (a kind of “ordination”) are considered. “Salvation” examines the process of dying. A brief analysis of Tolstoy’s “The Death of Ivan Ilych” (preoccupied with the soul) and Roth’s Everyman (concentrating on the body) is included. Carlin also spotlights cardiothoracic surgeon Dr. Denton Cooley and muses whether specialty physicians – surgeons, cardiologists, oncologists, psychiatrists – might be today’s “high priests”? “Prophecy” focuses on Stephen Bergman, MD (pen name Samuel Shem) and his novels including The House of God. Regardless of religious preference (or atheism), readers will find enlightenment in this intriguing inspection of the links between medicine and religion.
 

Every One Still Here: Stories by Liadan Ní Chuinn 

London: Granta, 2025, 160 pages 
ISBN 9781803513270 

The protagonists of these six short stories (largely set in Northern Ireland) have so many serious questions. But when they sometimes do get answers, the information is hardly good news. The narrator of “We All Go” is an empathetic teenager who has watched his wheelchair-bound father wasting away (probably from a neurodegenerative disease) and dying. He enrolls in a Human Anatomy class (perhaps to better understand his dad’s condition) but finds the lab itself and the required dissection disgusting. Other characters in these tales tend to be sympathetic, off-beat, or both: a psychic who isn’t adept at predicting the future but instead offers an effective form of psychotherapy, an unemployed woman taking night classes in creative writing who encounters a child (unaccompanied by parent or other adult) riding the same bus as her every week, a man who tries to commit suicide after learning his pet dog has metastatic cancer. Struggle, trauma, grieving, or some secret are prominently featured. A character wonders, “Isn’t the truth that we all do terrible things?” (p64). Indeed, acts of cruelty impact the lives of multiple individuals in these tales. For a few of them, compassion from others and the passage of time might ease the pain a bit but cannot completely erase it. 

Water in the Desert, Fire in the Night by Gethan Dick 

Dublin, Ireland: Tramp Press, 2025, 268 pages 
ISBN 9781915290168 

Long before the onset of Covid-19, Pandemic Lit was already an established subgenre of speculative fiction. For example, The Last Man by Mary Wollstonecraft Shelley was published in 1826. Like most novels about pandemics and other apocalyptic events, fear and hope are tightly intertwined in Water in the Desert, Fire in the Night. But this story’s journey thru the end of the world – about the things we leave behind and the qualities we stubbornly cling to – feels much more optimistic than most. An estimated 90% of the world’s population has expired, and a “raging sadness” has washed over most of the survivors. Details about the contagion are vague. The deaths it causes are devoid of drama or gore: “just a cold, a fever, some difficulty breathing, then no more breathing” (p236). Six people, afraid of being infected, hide in London for two months. Four of them decide to bicycle much of the way to an Edenesque-sounding town in France. The story’s narrator, Audaz is a young woman firmly tethered to memories of her younger life and her mother. She is also pregnant. Sarah, a retired midwife trains Audaz as her apprentice (since someone will have to know how to care for women’s health and deliver babies – if there is to be a future for humanity). Pressure Drop is a weed-smoking mystic, and Adi is a young man who succumbs to sepsis along the way. A variety of challenges test them throughout their trip. Survivors they encounter can be violent, suspicious, or kind. A fisherman transports the group in a borrowed boat across the English Channel to France where they eventually reach their destination. While survival remains their highest priority, these characters understand that compassion, resilience, and childbirth foreshadow a promising new beginning for them and perhaps the rest of the remaining world as well. 

Additional recommended new or soon-to-be published books in 2025: 

Seminal: On Sperm, Health, and Politics edited by Rene Almeling, Lisa Campo-Engelstein, and Brian T. Nguyen  

Replaceable You: Adventures in Human Anatomy by Mary Roach 

Web image by  Rachael Ren 

One of the most successful patient-artists was Auguste Forestier, hospitalized at Saint-Alban at the age of 27 after placing pebbles on a train track and causing a train to derail.  After his discharge from treatment, Forestier remained at Saint-Alban for the rest of his life, where he worked in the kitchen. He began to create toys for the children of hospital employees using discarded materials, even butcher’s bones.  In this exhibition we see not only a boat created by Forestier from scraps of wood but also a print of Tosquelles proudly holding up one of Forestier’s boats.  

The work of Saint-Alban artists came to the attention of French artist Jean Dubuffet, who, after reading the 1922 book Art of the Insane, had founded the Art Brut (also known as Outsider Art) movement.  Dubuffet’s attempts to collect it were at first greeted with skepticism by Tosquelles.  However, the success of Forestier (eventually he even came to the attention of Picasso) was such that the profits from his work were used to help fund the hospital.   

At its previous venues in Europe (the show originated in Barcelona) a larger number of pieces from Saint-Alban were displayed.  At its US venue, the show has been augmented with work from American asylums, which prove to be a highlight of the exhibition.  Even without a Tosquelles to inspire them, these patients created beautiful and fascinating art.  

We see, for example, a coat made by Myrllen, a schizophrenic patient from Tennessee.  The patient had reportedly worsened in response to such few treatments as were available at the time.  In desperation, she was given discarded rags and threads.  What she produced gives us a window into her condition, with strange words and figures whose meaning was known only to her.  Ironically, after making several such pieces the patient lost her creative impulse and stopped sewing once put on Thorazine, the first antipsychotic medication.   

Another piece, a watercolor entitled “An Antarctic Scenery,” is one of the earliest known American asylum paintings (c. 1816).  The patient-artist, Richard Nisbett, in his paranoid imagination has chosen to depict “a fleet of murtherous Pirates” invading Antarctica. Nisbett was a patient at Pennsylvania Hospital in Philadelphia under the treatment of none other than Benjamin Rush, often considered to be the father of American psychiatry.  

Although the exhibition closes in August, a book (which will be for sale at the Museum and online) is expected to be released in November 2024.  The link to a virtual conversation with the show’s curators is given here:  https://www.youtube.com/watch?v=s9j3fMn0xJA (1 hour 19 minutes).

Francesc Tosquelles is frequently mentioned in The Rebel’s Clinic, by Adam Shatz,  a recent biography of the psychiatrist, Frantz Fanon.

A Tosquelles Glossary from the Barcelona exhibition is also a helpful tool: https://www.cccb.org/en/exhibitions/guide/francesc-tosquelles/237849 

Illustrations: 

Auguste Forestier (1887–1958, France) Untitled (Boat), 1935–1949, Wood, fabric, metal, leather, nail, 29 1/2 x 45 1/4 x 9 1/2 in. Centre Pompidou, Paris, Musée national d’art moderne/Centre de création industrielle, ART BRUT/Gift of Bruno Decharme in 2021, AM 2022-43. 

Romain Vigouroux (active mid-20th century, France), Francesc Tosquelles on the Roof of a Building at the Saint-Alban Psychiatric Hospital, Holding a Sculpture by Auguste Forestier, 1947, Gelatin silver print, 7 x 4 7/8 in Collection Family Ou-Rabah Tosquelles. 

Richard Nisbett (1753 England-1823, United States) An Antarctic Scenery, 1816, watercolor.  Collection of The Library Company of Philadelphia.  

American Folk Art Museum  
Lincoln Square, New York, NY 10023
Folkartmuseum.org