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

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

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

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

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

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

Crying in H Mart: A Memoir
Michelle Zauner

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

Web photo by Portuguese Gravit

Realizing he was a member of a tangled (a favorite word of the author) group of transsexuals, James felt himself trapped in a conundrum of gender (he felt and considered himself female) versus sex (he was genotypically and phenotypically male). “To me gender is not physical at all but is altogether insubstantial; it is soul, perhaps, it is talent it is the essentialness of oneself” (p.25).  

After some fruitless interactions with the medical profession, Morris travels to Casablanca in the summer of 1972 to undergo sex-changing surgery and becomes Jan Morris. Unlike many if not most transsexuals, post-operatively Morris fared quite well emotionally and was quite happy with the change.  

Jan Morris’s writing is as humorous and eloquent as James Morris’s was. She describes how magazines like Rolling Stone, publishers like Random House, and thousands of readers have never cared what gender or sex was holding the pen; how life changed in clubs, restaurants, and in taxicabs, where Jan met the first man to kiss her, post surgery, “in a carnal way” (p.151). Morris records that “all I did was blush.” 

As the chronicle of one sensitive and highly literate man’s journey from manhood to womanhood, Conundrum offers much commentary on the states of mind of a transsexual, a highly polished writer undergoing the humoral, mental, emotional, and cultural changes of such surgery.  

Prior to surgery, Morris writes about feeling deprived of an identity: “I realize now that the chief cause of my disquiet was the fact that I had none. I was not to others what I was to myself. I did not conform to the dictionary’s definition–‘itself and not something else’ ” (p.40-41). All Morris wanted “was liberation, or reconciliation–to live as myself, to clothe myself in a more proper body, and achieve Identity at last” (p.104). It took courage but it was worth it and Conundrum reads like nothing more, and nothing less, than a successful odyssey of the sexual soul. 

Jan Morris died in 2020, aged 94. 

Jan Morris: Journalist, Historian, ‘Writer About Place’ – Faculty of English

Conundrum
Jan Morris 
New York Review of Books Classics, paperback 2006: 176 pages 
Originally published by Faber and Faber, London, 1974 

Web image by medhum

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.

A Most Unexpected Path Laid by a Most Unexpected Disease

Dr. Ross Slotten chose family medicine to serve patients from cradle to grave. But, as he was entering practice, the AIDS virus was entering the community where his practice was situated, and he found himself serving patients much closer to the grave than the cradle. 

In June 1981, a few weeks before I began my internship in family practice [at Saint Joseph Hospital in Chicago], the Center for Disease Control in Atlanta had published the first report of a strange lethal infection among a cohort of gay men in Los Angeles. I had no clue then that the disease would soon kill friends, former lovers, colleagues, and patients; devastate tens of millions of people and their families worldwide; and consume my entire professional life and more than half my chronological one. (p.14)

From both the circumstance of time and place he found himself in, and the sense of necessity and compassion that claimed him, Slotten’s professional trajectory unexpectedly shifted away from traditional family medicine towards specializing in AIDS. His interest in AIDS, however, extended to personal considerations, because as a gay man, he was part of the population at risk, and harbored the same anxieties and fears he saw in his patients and throughout his social circles. His patients were principally gay men because of his geographic location in an established gay community and the resulting referral patterns. The book chronicles both his experiences as a physician taking care of gay men with AIDS, and his experiences as a gay man at risk for AIDS. For Slotten, these experiences were not independent of one another, which makes for rich insights on the complexities of both. 

Slotten spent a lot of time at Saint Joseph Hospital because his patients required intense medical support and specialized services. He tells how he and his practice partner pushed for establishing a specialized AIDS unit in the hospital. They bumped up against usual bureaucratic obstacles, plus a few more concerning issues specific to AIDS patients, but they ultimately prevailed. Slotten “was to spend the next fifteen years there, often heartbroken, occasionally inspired.” (p. 109) In contrast to his commitment, he recounts how some specialists he called for help with particular patients refused when told they had AIDS. Those occurrences stuck with him: “I couldn’t forgive those other physicians for abandoning me and my patients in the hours of our greatest need.” (p. 108)

With whatever little time he had left for volunteer and advocacy work, Slotten stayed local. He talks about the volunteer-run health clinics where he worked (e.g., the famed Howard Brown Clinic), and the housing facility he helped set up for homeless people with AIDS. He left protesting at the Food and Drug Administration, the National Institutes of Health, and the annual International AIDS Conference to others while he focused on his patients, his studies, his volunteer work, and his own safety.

The 2020s are approaching when Slotten writes about the preceding three-and-a-half decades. As he finishes the book he is still caring for people with HIV, but the horrible complications of AIDS are now infrequent since the availability of effective medications. His practice had been reliably stable and predictable for some time, a circumstance he could only dream of when he first started. That dream ended abruptly just as the book was released on July 15, 2020: Covid was surging.

Moments of Horror, Relief, Calm, and Then…

Slotten’s perspectives correspond with the trajectory of AIDS over the thirty-five years his memoir spans. Particular periods are discernable, beginning when gay men were presenting with illnesses associated with profound immunodeficiency of unknown cause. Another is the time of peak AIDS death and destruction represented by the moment in 1992 when Slotten hears from the Chicago Board of Health, “that no one had signed more death certificates in Chicago than I had.” (p. 122) The next moment arrives at the turning point when highly active antiretroviral treatment (HAART) became available, transforming HIV/AIDS for him “from a universally fatal disease…into a chronic one like diabetes…it was almost beyond belief.” (p. 186) Then the prolonged period of relative calm when AIDS became controllable—even preventable—with Slotten noting during a moment in 2016 that, “It had been almost a decade since I’d cared for someone with advanced HIV infection, and I hadn’t lost a patient to AIDS since 2004.” (p. 202)

The AIDS epidemic is known for and measured by the number of deaths that occurred. Slotten wants us to remember the misery the disease causes.

For those who didn’t experience that terrible time, or who’ve forgotten how terrible it was, let my chapters serve as a warning to the complacent and the ignorant: untreated HIV is as ruthless as any terrorist and as destructive as a nuclear device. (p. 3)

He drives this point home when he recounts the stories of individual patients tortured by Pneumocystis carinii pneumonia, Kaposi’s sarcoma, cytomegalovirus retinitis, herpes simplex infections, cryptosporidium dysentery, AIDS wasting syndrome, AIDS dementia complex, and progressive multifocal leukoencephalopathy among other medical horrors, and who often suffer many at the same time. And, all the while, he had little to offer but his wits and his compassion. 

Both attributes would be called upon again in 2020 as Covid struck. Though those with Covid did not produce nearly the fatality rate of AIDS, not nearly the severe comorbidities of AIDS, not nearly the stigma and prejudice as AIDS, and not any of the governmental insouciance seen with AIDS, it still caused a lot of death, suffering, grief, and misinformation at a time when only supportive care was available. Like AIDS, though, the Covid pandemic was transformed into a manageable syndrome with the availability of an effective vaccine, new antiviral agents, and better clinical management regimens.

Complacency remains a threat to the reemergence of any infectious disease. Indeed, AIDS is reportedly rising in poor and developing countries in 2026 as funding for AIDS treatment and prevention programs has been withdrawn from donor countries, mostly that from the United States. Lessons from Slotten’s book may thus be called upon again.

Notes

Book citation:
Slotten, Ross A. Plague Years: A Doctor’s Journey through the AIDS Crisis. University of Chicago Press, 2020. 224 pages

Plague Years is a good companion to the documentary film, 5B, which reports on how San Francisco General Hospital coped during the early years of the AIDS epidemic, and Rebecca Makkai’s novel, The Great Believers which features the stories of a group of gay men in Chicago also during the early years of the AIDS epidemic.

Dr. Slotten was a guest on an episode of The Clinic & The Person podcast to discuss his experiences during AIDS epidemic as he reported them in his book, and how well they match up with what we see in 5B and read in The Great Believers.

Web image by Medhum.org

For this Apollo on Call x W5H Book Club episode, Dave and Luki read Other Rivers: A Chinese Education by Peter Hessler. The book focuses on the quirks and challenges in the education system the author witnessed as a visiting professor in China. At the end, Dave and Luki reflect on an entire year of reading books about China, and how they feel at the end of this journey.

Check out Dave’s Substack for more! 

Web image created by Medhum.

There is nothing to read on the psych unit but a bulletin board listing the daily activities and some magazines. This makes Chihaya think about her relationship to books, which is a complex one. She muses that “it is every writer’s fear that our books will be the death of us” (p. 11) and humorously writes about how she once had a bookshelf that was so wobbly she worried it would topple over on her. However, the real damage that books inflict may be insidious. The author first began to read as an escape from her unhappy childhood, but she fears she now “love[s] books to a dangerous degree” (p. 20).  They have become her life to the extent that she does not know if she “would be anyone at all” (p.12) without them. A feature of her depression is that she has completely lost interest in reading. She half-seriously coins the diagnosis “bibliophobia” to describe her condition. It will take just the right book to cure her, and when she finds it, she begins to read again, and to heal.  

Over the course of Bibliophobia Chihaya tells us about the books that have been of vital importance to her, many of which she associates with relationships or with stages in her life. Eventually, she reads the DSM about her own psychiatric diagnosis, and she reads books that other people have written about their depression. Working with a therapist, she realizes she needs to move on, and she lets go of her academic career. By the end of Bibliophobia we learn that Chihaya has finally written a book, but it is not the one she was expecting to write. It is Bibliophobia.

Bibliophobia is an unusual hybrid of a book that is part literary criticism part memoir. The author has been influenced by numerous mental health memoirs including recent celebrated works by Donald Antrim, Esmé Weijun Wang, and George Scialabba.

The first chapter, the subsequent emotional journey of the author, and her conclusions all captured my attention. I must confess that much of the rest of this book interested me less for the simple reason that I had not read any of the books the author discusses in detail. I do not even think we have the same taste in literature. However, this may not prove to be a stumbling block to potential readers who are fans of Toni Morrison, Anne Carson or Anne of Green Gables, or who just love reading about books.

According to the American Psychiatric Association, stigma around mental health is common in Asian American communities. One praiseworthy attribute of Bibliophilia is how it calls attention to the challenges that these groups experience in accessing care. Chihaya, was raised by a Japanese father and a Japanese Canadian mother who “did not believe in the concept of mental health; everyone was either fine or just complaining” (p. 49). Growing up with the message that depression is “not for the children of immigrants [but] something that happen[s] to white people in independent films” (p. 7) it goes without saying that Chihaya cannot bring her symptoms to her parents’ attention. Filled with shame, it takes her many years until she can no longer ignore them. Fortunately, Chihaya has given us a book filled with insights that one hopes will inspire others to seek help.

Bibliophobia
Sarah Chihaya
Random House, New York, 2025, 214 pages

References:
https://www.psychiatry.org/psychiatrists/diversity/education/asian-american-patients
Web image from Wikicommons.

Five years into writing about her mother’s slow decline from a respiratory illness, Joanne Jacobson was diagnosed with a rare, life-threatening blood disease. That discovery dissolved the illusion that she and her mother had separate fates. “How could I continue writing about my mother as though I were observing her from outside the circle of Illness?” Jacobson asks (27). She can’t. And Every Last Breath becomes, as its subtitle discloses, “A Memoir of Two Illnesses.” Doubling its concern, Jacobson’s memoir in essays becomes a richer, more urgent, and ironic revision of her original project.  

With writerly attentiveness, perceptive intelligence, and some impatience, the four opening essays witness the negotiations that Florence Jacobson makes with her body, her environment, and her psyche. From a distanced perspective, Jacobson wonders at her mother’s courage and stubborn animal will to go on. Her mother’s slow pace and reluctance to let go—of her possessions, her habits, her life—initially frustrate and puzzle Jacobson. She even expresses impatience with the constant sound of her mother’s oxygen pump filling the apartment, the inconvenient bulk of the oxygen canister, the tangles of tubing connecting the machine with her mother’s nostrils.  

As Jacobson’s diagnosis closes the distance she perceived between herself and her mother, it ignites the memoir’s transformative insight. It’s first articulated at the end of the essay titled “Mirror Writing” and it sustains the rest of the memoir. Realizing that her mother might outlive her, Jacobson writes: “. . . I can no longer pretend that the ragged approach of death is likely to be smoothed by nature’s grace, or by the natural order. So long as I believed I was writing about my mother, I was able to hold mortality at a distance . . . Now in the mirror of my mother’s aging face I see myself” (29). In “Dead Reckoning,” when Jacobson learns that her blood is starved for oxygen, she hears her “own lungs fall into the thrumming motor’s pulse” of her mother’s respirator. Revising her response to the technology, she writes that it is “the sound of death being pushed mechanically away that is audible to me now—steadily asserting its nearness . . .” (63-4). Jacobson’s descriptions of her hospitalizations and treatments (“Written in Blood,” “If My Disease Were an Animal”) sharply observe her new understanding of herself and the “call to the imagination” that her experience issues (59). Jacobson’s elegant and vulnerable rendering of her efforts to survive pain, uncertainty, and terrifying treatments register her courage and will to go on.  

The final essays bring together the shared destinies of mother and daughter. Jacobson thinks of their relationship as “invisibly entwined, cellular,” as she recalls that mothers’ bodies can absorb the fetuses’ cells (88). In “Book of Names,” Jacobson’s closing essay, she and her mother recite the names in Florence’s heavily edited address book, tracking the alterations in the lives she’s shared. The recitation invokes the lists in Genesis. Begotten. Gone.  

Every Last Breath should be read. Its profound and startling reflections on mortality are lyrical, fierce, and deeply felt. At times readers take extravagantly metaphorical flights of the imagination. At times we’re immersed in revelatory scientific facts about the natural world and our human biology. This slender book melts other boundaries as well: between caregiver and patient, mother and daughter, self and other, personal and universal. It simultaneously challenges literary classifications, blending poetry, essay, and memoir. Read separately or together—either way can be satisfying—Jacobson’s brilliant essays refuse to let us ignore our shared vulnerability or the unpredictability of living in a body, as Jacobson once naively thought she could. 

Every Last Breath–A Memoir of Two Illnesses
Joanne Jacobson 
The University of Utah Press, 2020; 114 pages 
https://uofupress.com/books/every-last-breath/

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

A few years ago, a patient of mine, a young man, was diagnosed with bipolar disorder. In the middle of university, his grades suddenly nosedived, and he was found talking incoherently by his roommates, who called the police.

Not long thereafter, his mother, distraught, came to see me in the office. She told me the story of their lives. How she had struggled to raise him on her own in North America while her husband lived overseas and how she had pushed them to attend a renowned public school in the area. Now she wondered if she was to blame for the whole thing. Had she done something wrong? Had she pushed them too hard? Was this all her fault?

I’ve been practising as a family physician for Chinese Canadian immigrant patients for almost two decades, and my practice runs the gamut from newborns a few days old right on through to adulthood. Not only that, I grew up as a second generation Chinese Canadian immigrant, the son of two Chinese immigrants from Taiwan. And now I’m a parent myself, raising the third generation of Chinese Canadian immigrants. After all this, I feel like I should know a thing or two about Chinese immigrant parenting but the truth isn’t so simple. It’s probably closer to truth to say that Chinese immigrant parenting is something that I have lived through and have many strange and conflicted feelings about.

There is definitely a playbook that Chinese Canadian immigrant parents subscribe to. The playbook is an extension of the Chinese immigrant workhorse mentality. When you come to a country with nothing but hope and work ethic, you somehow create an ethos built around filial piety, discipline, and a strong sense of duty. This parenting model, tried, tested and true, reads something like this:

• A heavy emphasis on academics and education, with emphasis placed especially on mathematics and sciences.
• A high level of parental expectations.
• Combining the above two points creates the expectation that when it comes to your academics, you will outwork your lazy, North American counterparts
• A carefully curated collection of after school activities, always including some attempt at playing a classical music instrument. Even here, you will outwork your lazy, North American counterparts.
• Going to university. Once in university, you will once again, outwork your lazy, North American counterparts.
• Landing a well-paying job, preferably as a professional in the big three (doctor, lawyer, engineer). If not, then business. In all these fields, you will, once again, outwork your lazy, North American counterparts.

The playbook may sound draconian, but in many ways, it works. Asian immigrant children are known for succeeding academically. They make it into top university programs in large numbers, so much so that some people were worried that certain elite schools were starting to modify admission criteria to decrease Asian students’ enrollment.

Asian Americans disproportionately land jobs in medicine, law and engineering and as adults, do disproportionately well financially. All of this conveniently fits into the model minority myth. The myth says that all Asians are hardworking and reliable. They do well in school, they don’t complain, and they work hard in their upwardly mobile careers.

This heavy-handed approach to parenting gained parlance in popular culture with the publication of Amy Chua’s infamous memoir, “the Battle Hymn of the Tiger Mother.”

Published In 2011, the book was described as a parenting memoir by Yale Law professor Amy Chua and became an international best-seller. In the book, Chua described her parenting journey, as she demanded, insisted, and pushed her children to academic and musical success. Her older daughter ends up performing at Carnegie Hall and eventually, in the years after the book was published, both daughters graduated from Harvard University.

I read the book a few years after it was published. From all the press clippings and popular discourse about the book, I had expected that the book to present a bullet proof justification for tiger parenting.  And indeed, the mother in the book was certainly recognizable to me. She was an amalgam of many of the Chinese immigrant parents I had known growing up, including some aspects of my own.

The book does in fact, describe many classic tropes of the typical Asian American parenting regimen. The disproportionate emphasis placed on learning classical music instruments, the high strung, pushy helicopter parent, the unrelenting expectation of academic success. Chua described booking family vacations only at hotels where a piano was available to be rented.

But what I did not expect was that this was only the setup of the book. In the second half of the book, Chua’s defiant younger daughter, Lulu, decides enough is enough and refuses to give in to her mother’s insistence on playing the violin. In time, she reduces her violin practice time to a measly thirty minutes a day and takes up that most un-Asian of pursuits, sports in the form of competitive tennis, and Chua concludes that the best form of parenting is neither something entirely tiger, but something in the middle, a cross between east and west.

In a culture where few people read but everyone likes to give an opinion, the book’s denouement was lost on most people. Amy Chua and the term “tiger mother” became an avatar for all the aspects of Asian American parenting that were deplorable, but few people chose to remember Chua’s tongue in cheek look at her own parenting.

Instead, the reaction of most westerners to the “tiger mother” phenomenon was one of disbelief, something along the lines of “those crazy Asian parents and their crazy parenting ideas.” But what I found most interesting was Asian people’s response to Chua’s book. Most Asian parents did not see Chua’s style of parenting as harmful or strange. Extreme, maybe, but in principle, no different from any other Asians. In my family, my cousins and I read the book and decided that our parents weren’t really tiger enough. Yes, we had been forced to play the piano and the violin. But not for six hours. Six hours! Can you believe it? Now that is crazy.

As much as I’d like to be critical of Asian American parenting, I must say that in my time with my Chinese Canadian patients, I’ve seen plenty of success stories.

I’ve had patients who find time to play both the piano and the violin while commuting an hour each day to the most elite merit based private schools in the city.

I’ve seen children who are being shuttled between all manner of competitive swimming, gymnastics and ice hockey lessons. Often, just hearing these children’s schedules is enough to make me dizzy but the families somehow make it work.

Sometimes, I’m tempted to ask the parents if it’s possible that they could just let their foot off the pedal and let their kids be kids. That’s the western upbringing in me coming out. But then I remember how in elementary school, one day my teacher asked us to tell the class what after school activities each of us was involved in. This was the late eighties, when over-parenting wasn’t really a thing yet, and I remember how my classmates howled with laughter as I rattled off all the strange extra-curricular activities my parents would be toting me to that summer: piano lessons, swimming lessons, tennis lessons, Chinese school and a cooking class. Most of my classmates were lucky to have one activity to do. I had five. At the time, I laughed along with them, finding the whole thing funny. But now, decades later, when it comes to parenting, I wonder who really gets the last laugh.

At the opposite end of the achievement spectrum, is the Otaku child. The term Otaku is Japanese and was initially a reference to Japanese youths who were obsessed with computers and popular culture. The classic example was the nerdy Japanese boy, imbibing huge quantities of Japanese anime and manga while sitting in their rooms playing video games all day. This was a mostly Asian phenomenon, rarely talked about in the west.^⁠1  In the last several years though, especially since the COVID pandemic, I’ve watched as a growing number of my adolescent patients stopped attending school. I’d find out about these cases from exasperated parents, who would come to the office, often alone but sometimes accompanied by their taciturn child, seeking out a medical solution for what was going on.  

The cases had some similar themes, though none was exactly the same as the others. In most of the cases, the child did not have a strong relationship with their parents. Often they had retreated into an online world on the internet. Sometimes, online gaming was involved, but sometimes the children insisted they just surfed the internet, watching videos or engaging with social media.

Generally speaking, the children weren’t terrible students in the traditional sense of children who were really struggling academically. They were mostly strong students. Several of them were even identified as gifted.

Poor sleep habits were often an issue for these children. They’d often be on their computers into the wee hours of the morning, and then unable to wake up for class, if they bothered to attend at all. Eventually, they’d stop attending classes altogether.

The children tended to spend much of their time in their rooms, rarely interacting with the household, often not joining their families even for meals. As the frustration of the parents grew, so too would the hostilities in the household. The parents would try to break the internet addiction by withholding computer hardware or turning off the WIFI. Such escalations would be met with confrontations, leading to overturned television sets or even suicidal gestures.

The ages of the children varied. Some were as old as high school. But some were as young as middle school.

In all cases, the commonality was that the parents were stuck. They didn’t know how to proceed. And as their family physician, I didn’t know either.

When I went to medical school, school absence was not a medical diagnosis. Neither was video game addiction. But the medical and psychiatric world I was trained in did not have cell phones or social media or Facebook or TikTok. What it had was a few narrow definitions for similar behaviours: conduct disorder, oppositional defiant disorder, and substance abuse disorders. The children in these school avoidance cases fit some of these definitions, but never wholly.

I’ve watched as parents tried everything they could to find a solution for this issue within a medical system that doesn’t really know what to do with these cases. Beleaguered parents bringing their children to see me is only the first step. I’ve sent these patients to see psychiatrists and psychotherapists and paediatricians with mixed results. There isn’t much these specialists can do with an uncommunicative child who doesn’t want to be there. I’ve seen patients call the justice of the peace to issue a community treatment order so that their own child gets ordered by the courts to go to a hospital for an assessment by a psychiatrist. I’ve seen patients drag their child to the emergency room for school absence and read consult notes by well-meaning ER doctors who try their best to persuade the child to resume going to school. I’ve even been called by well-intentioned police officers, who want me to do something about the child they’ve just been dealing with, because they have no idea what they should be doing either.

Of course, school absence isn’t something that’s new or wholly unique to Chinese immigrants. I still remember my first week of high school back in 1992, watching as a classmate of mine was dropped off by his mother at the front door, and as soon as the car disappeared down the road, he turned around and headed away from the school building.

But that was high school and for whatever reason, in those days, we never thought of those kids as being “medical cases.” If you wanted to blow off classes and spend your day smoking cigarettes just off the school grounds, that was your choice. It wasn’t something you dragged your children to see a doctor about.

In fact, the “high-school dropout” has always been a known character trope, around for probably as long as organized education has existed. But there’s something especially jarring when seeing these cases of high school dropouts play out against the backdrop of tiger parenting and the model minority myth. And there’s something even more visceral to it when the issue starts to appear in middle school aged children.

I wish I could say that all of these stories of school avoidance end well. Some of them do: after a few years of feuding with their parents, the child grows up, and some go back to school. But for others, the jury is still out. I’m still waiting to see what happens.

So what does it all mean? How can well-intentioned Chinese Canadian immigrant parenting, produce such a broad spectrum of results? Super successful overachievers on the one hand, and Otaku adolescents who refuse to leave their rooms and are on suicide watch on the other?

I don’t have an answer, except to say that both of these groups of children are products of the same parenting paradigm. And just like when my patients ask me if they are to blame for their children’s mental illness, there is no real answer. There’s no way to definitively connect a line between the Asian parenting model and the types of children it produces.

But just as we can draw a line between pushy, tiger parenting and academic success, we probably can also draw a similar line between pushy, tiger parenting and Otaku children and social withdrawal. It’s easy for the Asian parenting model to claim its successes, but it’s time for the Asian parenting model to also accept some of the damage it has wrought onto its children.

Ultimately, most of my paediatric patients go through to university. The majority are in the typical model minority fields: engineering, computers, medical school and law school. 

But occasionally I’ll meet one who is studying something a bit more off the beaten path: fashion, or design, or cinema or something like that. They may be taking degrees in those programs, or they’ve pivoted after university and are making their way far off the traditional, beaten path. I’ll look at them, I’ll know that in some small way, they’ve broken out of the paradigm. I know they’re putting their parents through agony, but for what it’s worth, I’m proud of them.

1. I remember a lecture in medical school talking about the cultural basis of diseases. Certain diseases were common in the West but almost unheard of in Asia-the example of eating disorders was given. For the opposite example of diseases common in the East but rare in the West, the example given was the Japanese Otaku child.
Web image created by Medhum.org

Photo of the Hsu family in the 80s provided by Dave

Additional Chapters from A Chinese City Doctor’s Notebook

When Your Body Isn’t Yours 

01.12.26 808

From Tigers to Otaku

09.16.25 1687

The Happiest Couple

07.28.25 1423

The Things We Don’t Talk About When We Talk About Dying 

05.13.25 2005

One Patient, Two Systems 

02.24.25 2691

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 

The Iranian-American author, Azar Nafisi (b. 1955), reminisces about her experiences teaching English literature in Iran before, during and after the revolution and the Iran-Iraq war (1980-1988). The book opens near the end of her sojourn in Tehran. A small group of young women, who have been friends since they were University students, gather in the author’s home to read and discuss English novels. They wear western clothes, remove their veils, and eat sweets. Some have been in prison. They conceal their simple purpose from fathers, husbands, brothers, because meeting to read Western fiction would be construed as an act of defiance.  

In four sections, two named for twentieth-century novels and two for nineteenth-century authors — “Lolita” “Gatsby” “James” and “Austen,” Nafisi constructs a series of flashbacks that describe the events of late 1970s to the 1990s in the inner and outer world of an academic woman. The books and writers used in the section headings have walk-on parts or starring roles that jar in this ostensibly alien context. Yet, they work surprisingly well for the women students, stimulating them to think in new ways about the situation in which they find themselves. Conversely, as the students assimilate the English and American writers into their world, we learn more about their Iran. 

Myriad details of moment, garb, color, and food, evoke the everyday “feel” of protests and atrocities that are known in the West only through journalist’s reports. The long descriptions contrast sharply with a relentless and probably deliberate lack of precision about several basic things. For example, the author withholds her age and the identity and the nature of her relationship with “my magician,” a greatly admired man –perhaps a lover or a teacher–who seems to exist on chocolate and philosophy.  

Possessives and the first-person singular are used liberally (“my students”) to remind us that this is one woman’s story—notwithstanding the solace, but barely developed presence, of a husband, two children, and a mother. The decision may have been made to protect personal privacy. But the result also conspires to build a narcissistic tone, as if the author marvels at her own creativity, attractiveness, resilience, survival, and escape.  

Some of the most engaging passages describe the male students’ difficulty with literature that they perceive to be immoral (for its sexual content or for the agency it assigns women). In the social climate, the young men are utterly unable to accept great writing on its own terms. One wonders how they would react to Nafisi’s own book and her portrayal of them. The wonderful device of a mock trial of Gatsby (pp. 120-136) challenges the students by going to the heart of the conflict of politics, religion, literature, and justice; it would work well as an excerpt and is worthy of emulation in our classrooms. The work deepens our understanding and complicates the impressions of Iran that are generated by a steady diet of news reports. 

In 2024, Reading Lolita in Tehran became a film directed by Israeli filmmaker Eran Riklis. 

Born into a privileged, Iranian family and educated in both England and the United States, Nafisi saw the great changes in her beloved country as the encroachment of a retrograde, unthinking tyranny, hostile to women and to reason. She moved to the United States in 1997 and became a citizen in 2008. She has served as a professor of English literature in several universities, holds at least nine honorary doctorates and numerous awards and prizes for her creative work. 

Reading Lolita in Tehran
Azar Nafisi
Random House, New York 2003
347 pages

From the Vault:
In these times, certain works of literature seem to be as relevant to us now as when they were published — possibly more relevant than the times that they depict. From the vault of the now closed Literature, Arts and Medicine Database, we will pluck a few items for their power and timeliness.

Web photo by  ariyan Dv