Far less dramatic—not even in the same league, but disturbing in its own way—is the record of psychoanalysis during the Third Reich (psychoanalysts were not involved in the two programs mentioned above). Psychoanalysis, pejoratively referred to as “the Jewish science” by the Nazis, was of course created by Sigmund Freud in Vienna. One of the early and seminal centers of treatment, research, and training was the Berlin Psychoanalytic Institute, founded in 1923 (it grew out of the Psychoanalytic Polyclinic, a free clinic founded three years before) by Max Eitingon, who was the director. Many of the faculty, including Eitingon, were Jews; several were also socialists.

When the Nazis came to power in 1933, the Institute’s days were clearly numbered; not only because psychoanalysis was considered “Jewish” and so many psychoanalysts were Jewish, but also because its goals of individual growth, self-knowledge, and independence were directly antithetical to the mindset that a totalitarian government wanted to impose. Freud was now anathema, a new language of “Aryan” terms for analytic principles was devised, all Jews were purged, and the focus of psychoanalysis in Berlin shifted to the furthering of Nazi ideology: treating “war trauma” in soldiers and SS men, prioritization of and obedience to a totalitarian mindset, “reorienting” dissidents towards approved National Socialist thinking, conversion therapy as a treatment for homosexuality, and the like. The talking cure was to be weaponized for state purposes.

Seven months after Hitler seized power, Freud wrote to a colleague in England, “Berlin is lost…” Eitingon was forced to resign and fled Germany and was replaced by two Aryan analysts as co-directors. Three years later the Institute was subsumed into the German Institute for Research and Psychotherapy, known as “the Gӧring Institute,” with a new director, Matthias Gӧring, cousin of Reichsmarshall Hermann Gӧring.

The Institute’s excuse for collaborating with the regime was that it was the only way to “save” psychoanalysis and permit its survival; Freud himself had early on counseled accommodation as necessary to accomplish this end. What the Institute learned was that there is no accommodation short of full cooperation in a totalitarian state. But what was the toll of compromise on the men and women left in the Institute?

This was the history of psychoanalysis under the Nazis, which has been reviewed in a number of scholarly works¹. The novelist Stephen O’Connor has set himself a different task: to examine the life of a fictional non-Jewish German psychoanalyst as it played out against the background of Berlin and the Berlin Psychoanalytic Institute before and after the Nazi seizure of power in January 1933. His new novel, We Want So Much to Be Ourselves, follows its main character, Günter Zeitz, from his initial meeting with Sigmund Freud in 1924 through the years of the Third Reich and beyond. Günter will be our avatar, our surrogate participant through whose eyes we will watch things play out, during the heyday of psychoanalysis and through its suppression. However, the novel is not primarily about the destruction of German psychoanalysis, but about Gunter during the destruction of German psychoanalysis. Günter will be Exhibit 1 in the case for the acute and lingering effects of trauma.

As the novel opens we meet Günter corralling Freud on a street corner in Vienna and asking him to take him on for analytic training, which will consist largely of Günter’s personal analysis, and Freud agrees. In the doctor’s waiting room Günter meets another patient, Josine Rosen, a Jewish woman, and shortly thereafter they begin an affair. It becomes clear that Josine is troubled; she has already had a suicide attempt, and is subject to bouts of depression, but Günter is in love and within a year they marry and soon thereafter have a daughter, Hannah. Despite their ongoing disputes about some aspects of Freud’s “death force” theory, Freud recommends Günter for a position at the prestigious Berlin Psychoanalytic Institute, which he accepts. Over time, the course of true love does not exactly run smooth; Josine is unstable, and the National Socialists are increasing in power and presence in Germany, posing a problem for her as a Jew. Günter and Josine will separate and reunite several times and draw others into their story as their world descends into a very rigidly structured type of chaos. How they all navigate this personal and professional turmoil determines the rest of their lives.

Meanwhile, we listen in as the analysts at the Institute discuss the increasingly dangerous situation, and how to respond. They initially dismiss Hitler and his “gang of toothless throwbacks” (p. 127) as upstarts with no political base and no future (as does much of the German public) until 1933, when it becomes apparent that this is no longer the case. In 1936, after Matthias Gӧring assumes the directorship, new rules for psychoanalysis are introduced; complying with these changes is clearly the only way the Institute will be allowed to continue to function. Some analysts flee, some accommodate, and some join the resistance.

However, the novel is really Günter’s story. Günter is eminently likeable; he is a bright, engaged and engaging character pursuing his academic dream who genuinely wants to mitigate human suffering. We watch him grow from the sheltered son of a country doctor to a confident teacher and practitioner, and we watch him fall in love, repeatedly, almost as though he is “feeling his way” in this world of emotions. When the Institute is taken over and its direction changed Günter finds himself in a moral quandary: he is horrified by National Socialism but feels unable to do anything about it. Can there be a small degree of accommodation, to allow him to continue to help those who need help, or is accommodation a slippery slope which ends in a betrayal of self and principles? Silence or resistance? We watch with him as he tries to keep his professional life intact as his personal life begins to unravel. When he is forced to treat Dr. Gӧring’s nephew, an SS lieutenant recently returned from a murderous detail in the East, he reaches his personal Rubicon.

Günter is an everyman caught in the gears of a machine, and the kernel, the gist, of the novel, is a question: how does one go on living one’s life in a system gone mad, and what are our responsibilities to others and ourselves? How do you go to work and go home to your family, how do you love and hate and gossip and drink your coffee and read your newspaper and pick up your paycheck and go to a movie, when you are convinced that a great evil is being perpetrated, that you are told to be part of it, and that any false step on your part might bring that evil down upon you? When it is your country and your countrymen and your colleagues doing it? What is the personal cost, the cost to yourself, and to your self, when—if— you come out on the other side of the madness?

The other characters, and their interplay, are handled carefully and realistically. Josine is a large and critical part of the story. She is clearly—and sadly—damaged, and her behavior is too erratic for us to “like” her, although she engenders tremendous sympathy . She is a tragic figure and we feel for her, although this is not always easy. The student analyst Elke Weber, who becomes a critical participant in the story, is drawn realistically and sympathetically. Hannah will become important as a character in her own right later in the book. The other characters in the novel, including some of the historical figures, are drawn simply but cleanly and expressively; the reader feels that they know them, if only briefly.

We Want So Much to Be Ourselves is well-written, engaging, and suspenseful. O’Connor’s narrative successfully summons up both the atmosphere in the world of psychoanalysis in the 1920’s and Nazi-era Berlin’s anxiety and paranoia in the 1930’s. The reader who has some familiarity with the history of Weimar and Nazi-era Germany will note a rare factual slip², but nothing that is critical for plot development or that takes away from the pleasure of the reading experience; such are the pitfalls of writing historical fiction. When we reach the last hundred pages or so—the postwar years—the narrative tempo speeds up, and near the very end the novel becomes telescoped into a series of rapid-fire moments in the protagonists’ lives, seeming more an epilogue than a continuous part of the novel; this is the section that catalogues the aftermath. Life hobbles on, though one might wish for a more leisurely unwinding of the tale.

We Want So Much to Be Ourselves asks how a person of moral integrity can function in what the German philosopher and psychiatrist Karl Jaspers has called a Verbrecherstaat, a “criminal state”—not simply a state that occasionally commits crimes, but a state which has been transmuted entirely into a criminal enterprise—and what the price of that functioning, of complicity or resistance, might be. It portrays profoundly human characters who live through societal trauma, from which it is possible to emerge, but rarely to emerge unscathed, and emphasizes the role of connection for moving forward and healing. Importantly, it reminds us that patient care does not exist in a vacuum or a pure state, divorced from the society that surrounds it, and that when it is co-opted and weaponized by political considerations, things go very bad, very fast.

We Want So Much to Be Ourselves
Stephen O’Connor
Bellevue Literary Press, New York 2026: 496 pages
_______________________________________________________
¹The history is complicated…and contested; see Geoffrey Cocks’ “The devil and the details: psychoanalysis in the Third Reich,” in Psychoanalytic Review, 88 (2), 2001; Zvi Lothane, “The deal with the devil to “save” psychoanalysis in Nazi Germany” Psychoanalytic Review, 88(2), 2001; and Cocks’ review (in Psychoanalysis and History 3(2), 2001) of James and Eileen Goggin’s Death of a Jewish Science—Psychoanalysis in the Third Reich, among others. The Goggins feel that psychoanalysis was “destroyed” under the Nazis, while Cocks notes significant continuities in the discipline through this period, although his analysis includes psychoanalysis and psychotherapy.

²At one point one of the characters is said to have been arrested by the police and “…got off the train at Theresienstadt and went straight to the gas chamber…” (p. 425) While the person narrating this event is admittedly unsure that the prisoner went to the gas chamber, the fact is that they could not have; there were no gas chambers at Theresienstadt. In another example, a patient of the Berlin clinic is referred to as a “Leninist” who was a member of “the DKP.” The author is presumably referring here to the German Communist Party, known as the DKP, or Deutsche Kommunistiche Partei. However, the DKP was only founded in 1986. The Communist party in Germany during the Weimar Republic and (though it was rapidly outlawed) in the Third Reich was the KPD (Kommunistiche Partei Deutschlands).

Web image by Medhum.org based on the original book cover.

The diagnosis and clinical management of various mental disorders are aided by knowing the predisposing, precipitating, and perpetuating factors in a given case. Both the themed album and the full-length movie of Pink Floyd’s, The Wall, depict these factors in the course of the main character’s—”Pink’s”— mental health deterioration through music and film. In this episode, we draw from selected songs on the album and from selected scenes in the movie connecting the three factors with particular behaviors Pink manifests. In the process, we show how they are used in medical education and training in real time.

Joining us is Dr. Anthony Tobia, who is the campus chair in the Department of Psychiatry at the Rutgers School of Medicine and is also the Service Chief of Psychiatry at Robert Wood Johnson Barnabas Health in New Brunswick, NJ. Dr. Tobia is certified by the American Board of Psychiatry and Neurology and is certified in internal medicine and psychosomatic medicine. He also holds a secondary appointment in the Division of General Internal Medicine at Rutgers. Dr. Tobia is the Director of Graduate and Interprofessional Education at Rutgers University Behavioral Health and has received the Outstanding Clinical Faculty Member Excellence Award in 2018 and 2019. He is an active contributor to the medical literature with publications, reviews, and abstracts. Dr. Tobia’s educational interests include the merging of popular culture and the field of behavioral medicine, which is evident from this episode and from his previous appearance on the podcast episode featuring The Who’s Tommy. Along with Dr. Tobia for this episode is Kevin Frederiks, who at the time of recording, was a fourth-year medical student at Rutgers.

Citations
For the recorded album: Pink Floyd. The Wall. Columbia Records, 1979.
For the movie: Parker, Alan, director. Pink Floyd The Wall. MGM, 1982.

Link
Please send us comments, recommendations, and questions here, or email to: ru***************@***il.com.

Thanks to Dr. Anthony Tobia and (by now) Dr. Kevin Fredriks for their interesting and insightful contributions to this episode. 

Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts.

Web image by Russel Teagarden

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Why did you write this book?

I’m encountering more and more people over the last few years, particularly post-COVID, who have the perception that the categories we use in psychiatry have a kind of fixed, objective, and quite rigid reality. Twenty years ago, when I started as a GP, I might have seen somebody who said, “I feel anxious all the time,” whereas now I’m more likely to meet somebody who’ll say, “Well, I have generalized anxiety disorder.” That’s a shift in the way that society talks about mental illness. At the same time, a lot of people are questioning these categories’ usefulness, so there’s a paradox—a sort of polarization.

I wanted to write a book which explains, from my perspective, A, how the way we think about mental illness has always been shifting and evolving. How we think about mental illness changes with culture, time, and geography. And B, if we can adopt a more flexible and humble approach to our current understanding, that actually offers more hope to patients. Because believing “I have generalized anxiety disorder,” rather than “I feel anxious,” can sometimes be helpful, but it can also box you in and become self-fulfilled. I’m seeing that same shift across the whole spectrum of mental illness and suffering, and the book is a call to question that and reassess where we’re at in the mid-2020s—and a plea for a little bit more kindness and flexibility.

What would that look like in practice?

For example, if somebody comes to me saying, “Well, I have generalized anxiety disorder, so I can’t do this stuff,” part of my work is to help that patient adopt a more hopeful perspective: that there are strategies that they can learn, that there are medications that can help, and that our mind is shaped by many different influences. There may be explanations for their anxiety that have to do with the brain and neurotransmitters and so on. But in most people, there are also more influential factors that have to do with their early childhood experiences and their current social setup, the precarity of their relationships or their economic situation, the quality of their sleep, or the substandard nature of their housing. There are all sorts of other factors that are having a bearing on their anxiety that I would seek to help them explore, rather than them just blanketly saying, “I have generalized anxiety disorder—can you give me the pill for that?” I’m trying to encourage my patient to say, “Yeah, there are pills that can help. But there are all these other factors that we need to think about. And do I really find that label helpful?” For some people, once you start to dig into it, they don’t.

We can extend that way of thinking to people who’ve had a psychotic episode. Between 10% and 20% of people who have a psychotic episode will never have another. For substantial numbers of people, their psychotic episode is actually a product of all sorts of stressors that are on them at that time. If you can find a way to modify their stressors, put them in a more supported state, and understand what place that episode has in the story of their life, you can then make a story that makes sense of that episode as the product of a uniquely difficult moment in their life. That can help people get over that episode and also, I hope, make it more likely that they don’t have subsequent episodes. Or, if they do, then they’re able to return fully to their normal functioning in between.

You write, “For the last forty years much Western psychiatry has behaved… as if our thinking is a simple matter of chemical levels in the brain. The truth is far more complicated.” For example, a 2023 study you cite challenged the serotonin theory of depression. [1] Why do you think that the chemical imbalance narrative has persisted?

There’s a number of reasons. That hypothesis came through at a time when our lab technology was starting to be able to measure neurotransmitters, and it offered a good story. If you become depressed, you feel as if you’re lacking something—as if you’re lacking some kind of fuel or energy. That lack translates very easily, in our metaphor-making minds, to the idea that there must be some kind of lack between our brain cells.

At the same time that this technology was becoming widespread, there was the promotion of a drug which seemed to help: Prozac. There’s no doubt that SSRIs do make a difference. Again and again, they’re shown to be better than placebo. The effect is probably a lot smaller than a lot of the drug companies would tend to promote in their materials, but they do help, and I continue to prescribe them. But what that study you’re referring to was saying was that, even if these drugs help, they don’t help by boosting serotonin levels. We can’t find evidence that substantiates that theory.

The first half of the 20th century was governed by Freudian ideas. Psychiatry in much of the West was dominated by those kinds of psychoanalytic ideas. Then, during the ’50s and ’60s, as we started to develop tricyclic antidepressants and experiment with other kinds of antidepressants—the first were anti-tuberculosis drugs—the idea grew that there might be a chemical solution, which fit very well into our technologically and pharmaceutically focused medical culture. Then, from the late ’90s, there was a huge explosion of the idea that, actually, a lot of it was genetic.

Now, even the idea that neurotransmitters are strictly excitatory or inhibitory is starting to be questioned. Essentially, the whole picture is vastly more complicated than the neurotransmitter hypothesis from the ’90s suggested. I don’t take that as a great failure of the hypothesis; it was an attempt to make sense of something very complicated, and the drugs that spoke to that metaphor are useful and are still among some of the most widely prescribed in the world. But the fact that we no longer think that low mood is purely because of low serotonin is a really positive step forward. It encourages us to embrace more fully the biopsychosocial approach to mental illness. The field of psychology and psychiatry is not known for consensus, but one thing everybody agrees on is that it’s not just biology, it’s not just psychology, and it’s not just sociology—it’s all these influences that have an effect on our mental health.

Are there other common assumptions about mental illness that you think deserve closer scrutiny?

Every age uses the metaphor of its highest technology to make sense of the mind. In the 19th century, the mind was famously described as an enchanted loom; the mind was thought to be weaving our experience, moment by moment. We’ve now got these very pervasive metaphors of wiring, which I find quite unhelpful because the brain is nothing like a circuit board. It would be like a circuit board made of jelly that can fix itself. So I think the wiring metaphor, although it has its uses, has gone too far because it’s too deterministic. It’s not organic enough.

Half a century ago, Stanford psychologist David Rosenhan wrote, “A psychiatric label has a life and an influence of its own.” To what extent can psychiatric labels help, and to what extent can they hinder?

There’s a lot of controversy about the Rosenhan experiment. [2] He’s been accused of being a charlatan and fabricating quite a lot of his data. But I think the value of his reflections still stands. I’ve definitely seen in my clinical practice that people will be treated differently because of a label that has been put in their notes, even though that label might have changed several times. I’ve had patients who’ve had four or five different labels in the course of their career, while they’ve had actually pretty much the same kinds of experiences and distress throughout all of those.

What I find really helpful in my conversations with patients is the fact that we don’t always have to give a label. If someone is really keen for one, then I’m happy to explore that with them and tell them, “These are the psychiatric categories that are on offer in the current edition of the DSM. Some people find them really useful, but with every new edition of the manual, they change, so they’re not describing something discrete, fixed, or in the natural order of things. They’re a way of describing and approaching distress, so let’s talk about how much they would be helpful for you.”

Now, in the U.S., I understand that labels can be essential because of insurance-based medical payments. In a U.K. context, a label may not be as useful because our psychiatric services are organized differently. I gently explore with each patient how much for them it’s going to be transformative. If it’s going to help ease their suffering and get them the treatments that they want, then I embrace it and help them get the one that fits best. But if it’s not going to be transformative in terms of how they can access care, then I tend to try to avoid giving a label because that can allow a level of optimism and dynamism about their state of mind. It more genuinely reflects the possibility of change and adaptation, rather than risking somebody changing the way they think of themselves.

As human beings, we’ve got such a huge tendency to put shame on one another. What labels seem to do in our current moment is absolve people of that shame in a really helpful way. I’ve had patients say to me, for example, that until they got their diagnosis of ADHD, they felt so ashamed of not being able to focus properly at work, and what that label did was offer a kind of absolution from that shame because it said, “There is this category of being that is separate from you and which seems to be affecting you, but it’s not your fault.” That can be wonderfully liberating. In those kinds of situations, I’m often keen to embrace the label if it’s going to help the patient cast off their shame. But I’m also questioning: Why have we got that shame? Isn’t it a pity that people often feel that they need to embrace a medical diagnostic label in order to rid themselves of that shame?

What strengths do primary care physicians bring to mental healthcare compared to someone more specialized?

One great advantage of somebody in my kind of role is that I’m embedded in the community. I often know the whole family, and I’m seeing people for all kinds of other problems which have a bearing on their mental health. I’ve become more aware of the connections between families and individuals; a specialist only sees the one individual with a particularly distressing problem—for longer appointments, granted, but removed from that context.

There’s a wonderful GP writer in the U.K. called Iona Heath, who has written a lot about the fact that it’s in the primary care consulting room where suffering is either given a label and understood within a medical model, or not. Some people see primary care physicians as essentially holding a line, or acting as some kind of gatekeeper, between the huge mass of human experiences that are out there and which ones become medicalized. A lot of people will come and see me about something fairly banal—almost to try me out, to try and figure out whether I’m going to be kind, compassionate, friendly, or approachable. Once they’ve tried me with a symptom that they’re not too fussed about, then they’ll risk sharing the one that they’re really worried about.

As a primary care physician, I feel I have a very privileged role: You’re not part of the family, but you’re not part of the establishment—you’re somewhere between the two. I’m often the first port of call for people hoping to make sense of their experience.

One line from your book that struck me: You write that today’s DSM categories will one day “seem as overconfident as the old phrenology charts.” How literal or hyperbolic do you mean that comparison to be?

Phrenology was debunked about 130 years ago. By the late 19th century, it was already starting to lose its traction because good thinkers were realizing it was a load of rubbish. If I could fast forward to 2176 and ask the doctors of that time what they’ll make of the DSM-5, I don’t think they would see it as phrenology, but they would certainly see it as utterly obsolete and unhelpful to them because it’s a cultural document of the West in the early 2000s. We can’t imagine what Western culture is going to look like in 2176. I’d argue that it’s quite likely that it will be very different from our current culture, that our neuroscience and genetics will have progressed in huge leaps and bounds, and that the organization of our society—while it may not have progressed—will have changed utterly. The DSM-5 will be of purely historical interest. When I was born in the ’70s, they were using the DSM-II, which is now considered very much a historical document—and that’s within my lifetime. I’m hopeful that the DSM-6, if and when it ever appears, is going to be an improvement on the DSM-5.

What inspired the book’s title?

From my chair in the clinic, I don’t see people’s minds as brittle and fragile. I see people as immensely resourceful, resilient, adaptive, and dynamic. People are incredible; they always amaze me with their ability to get over even the most extraordinary difficulties, suffering, and traumas. In my seat, I see the mind as far more unfragile than a lot of the rhetoric in our culture suggests.

The Unfragile Mind: Making Sense of Mental Health
Gavin Francis
Publisher: The Experiment, New York. 2026. 256 pages.

[1] Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 28, 3243–3256. 
https://doi.org/10.1038/s41380-022-01661-0

[2] In the 1970s, Rosenhan and eight pseudo-patients feigned auditory hallucinations to gain admission to a dozen psychiatric hospitals across the U.S. Once inside, Francis writes, they “declared themselves free of the hallucinated noises, but found it very difficult to be believed, and be discharged” (p. 47).

Web image created from book cover by Medhum.

Back when I was doing my internship at Pennsylvania Hospital, I was so surrounded by history I felt like I was working in a museum. Even the china we dined on in the hospital cafeteria sported the original historic pattern. And when we finished our training, a brass plaque with our names went up on the same wall as the plaques of our predecessors going back to the 18th century.

At the time, none of this was widely known. But fortunately, Pennsylvania Hospital now has an actual museum, open to the public just in time for the nation’s 250th anniversary. The Pennsylvania Hospital Museum is compact yet chock-full of art, architecture, artifacts, and documents, and has at once become a must-see destination in Philadelphia.

Although Bellevue Hospital has roots that go back to 1736, it started out as an almshouse. Pennsylvania Hospital was the first institution in the colonies founded specifically as a hospital, established in 1751 by Benjamin Franklin and Thomas Bond. The 1756 building housing the museum is a National Historic Landmark. Not only is it considered an important example of Georgian architecture, but its cornerstone even bears an inscription by Franklin referring to King George II.

The landscaped grounds are a serene oasis in the middle of Philadelphia’s Society Hill neighborhood and include a Physic Garden containing herbs and plants used for medicines in the 18th century.

As one enters the building, the first room encountered is the pharmacy, which remained in use until 1927 and now contains interactive displays. A fire engine purchased in 1803 sits in the foyer at the base of a grand staircase. After ascending to the second floor, visitors enter America’s first medical library, a handsome wood-paneled room containing more than 13,000 volumes from floor to ceiling, including one of the nation’s most complete collections of medical books published between 1750 and 1850.

The third floor houses the nation’s oldest surgical amphitheater. In the era before electricity, it was illuminated by skylight, so surgeries could only be performed on sunny days. (I must confess that we interns used to sneak into this room when on call. It was spooky in the middle of the night!)

For me, as a psychiatrist, the highlights of the museum were the exhibits on mental health. I have previously written in MedHum about Benjamin Rush, often called the father of American psychiatry, whose portrait is on view here. Rush served on the staff at Pennsylvania Hospital from 1783 until 1813 and was known for his groundbreaking and humane treatment of the mentally ill. Metal shackles once used as restraints are also on display, although hopefully they predated Rush’s tenure.

Another psychiatric pioneer whose portrait hangs in the museum is Thomas Story Kirkbride, who came to Pennsylvania Hospital for residency training in 1834. When the psychiatric wards exceeded capacity and a satellite facility was built on 101 acres in West Philadelphia, Kirkbride was named superintendent. His ideas about the layout and design of mental institutions became highly influential, leaving an imprint on hospitals throughout the country.

Initially called the Pennsylvania Asylum for the Insane, the new campus eventually became known as the Institute of Pennsylvania Hospital. I completed my residency training there, but over time it was no longer financially viable, and it closed in 1997.

How fascinating to learn that Francis Scott Key, of “The Star-Spangled Banner” fame, wrote a poem titled On Visiting the Pennsylvania Hospital. And to see 18th-century anatomical casts used for teaching at a time when formal dissection was illegal.

There is so much history in this museum that I could not absorb it all in one visit. With its addition, Philadelphia further demonstrates its role as the cradle of American medicine. Indeed, one would have to travel to London to find a larger assemblage of medical historical sites.

In one very busy day—or a more leisurely two-day trip—a visitor can now experience this museum, plus the College of Physicians of Philadelphia and its famous Mütter Museum, while also stopping to see The Gross Clinic by Thomas Eakins. (The painting alternates between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, but will spend 2026 at the latter.)

Bravo, Philadelphia!

Benjamin Rush:  Reflections from a Psychiatrist 

Guy Glass 09.02.24 0

A founding figure in American psychiatry, known for pioneering reforms, but also controversial for his treatments and complex contradictions in beliefs and practices.

For more information about the museum, visit Pennsylvania Hospital Museum.
Web image from Wiki Commons

Although Stevenson’s fieldwork was unusually thorough, mainstream scientists rejected reincarnation as a viable explanation and instead focused on potential methodological weaknesses such as retrospective testimony, cultural influence, and the difficulty of ruling out information leakage. Stevenson described the cases as “suggestive,” but he made clear that reincarnation—or at least the survival and transfer of some aspect of personality—was, in his view, the most plausible interpretation.

The twenty cases in the 1966 volume represented only a fraction of the material Stevenson had been collecting since 1960. His early publications had attracted the attention of Chester Carlson, the inventor of the Xerox process, who left a bequest of one million dollars to the University of Virginia upon his death in 1968. The Department of Psychiatry used the gift to establish the Division of Perceptual Studies (DOPS), with Stevenson as its founding director. The name provided an academically respectable umbrella for research that included, but did not explicitly advertise, the study of children’s past-life memories.

Over the next three and a half decades, Stevenson and his colleagues expanded their investigations across Asia, the Middle East, Africa, Europe, and the Americas. By the time of his death in 2007, Stevenson had published twelve additional books and more than three hundred papers, documenting over 2,000 cases. In 1999, journalist Tom Shroder’s detailed investigation, Old Souls. The Scientific Evidence for Past Lives offered an intimate portrait of Stevenson’s fieldwork and helped bring the research to wider public attention.²

Leadership of the program passed to child psychiatrist Jim Tucker in 2002, when Stevenson retired.³ Tucker became Director of DOPS in 2014 and, in 2021, published Before, an updated synthesis of his own two earlier books. ⁴ Tucker reports that the DOPS database now includes more than 2,500 cases worldwide, including many from North America. Only a minority—roughly 15–25 percent—qualify as “strong cases,” meaning that the child’s statements were independently verified as matching a specific deceased individual.

The strongest cases share several converging features: verified statements about the previous life, verified identification of the deceased individual, physical correspondences such as birthmarks or birth defects, behavioral continuities, and early onset of statements. One of Stevenson’s most striking findings involved physical correspondences. By 1997, he had documented 210 cases in which a child had a birthmark or birth defect corresponding to a wound on the deceased individual, and in 49 of these, he obtained autopsy reports confirming the precise wound locations.⁵ These findings were presented in detail in Where Reincarnation and Biology Intersect and in his massive two-volume monograph Reincarnation and Biology.⁶

Here is an example of one of Ian Stevenson’s earlier strong cases. When Swarnlata Mishra was three years old, she began singing unfamiliar songs and performing dance steps her family had never seen, dances from a region of India more than a hundred miles from the family’s home. Soon she was describing a former life as a woman named Biya Pathak, recalling the layout of Biya’s house, the names of her children, and even a stash of money hidden in a wall. Stevenson documented her statements before any contact with the Pathak family, and when they eventually visited, Swarnlata greeted them with an ease and specificity that startled everyone present. She correctly identified family members, teased one man with a childhood nickname only Biya had used, and pointed out a brother’s limp. The encounter had the uncanny feel of a reunion rather than an interview, and for Stevenson it became one of the clearest examples of a case where detailed memories, personality traits, and verifiable facts converged before any possibility of normal information transfer.

More than half a century later, Jim Tucker encountered a very similar pattern in the case of “Ryan,” a young boy from the American Midwest. At age four, Ryan began speaking urgently about a previous life in Hollywood—describing movie sets, agents, and a bustling life in Los Angeles. His parents, who had no interest in reincarnation, tried to reassure him, but the boy’s distress grew until Tucker became involved. Using Ryan’s spontaneous statements, Tucker and the family identified a long-forgotten bit-part actor and Hollywood extra from the 1930s and 40s. Ryan had given more than fifty details about this man’s life, including the street he lived on, the name of a restaurant he frequented, and the fact that he had danced on Broadway before moving west. Many of these details were later verified in archives and autobiographical sources unavailable to the family. What made the case especially compelling to Tucker was not only the accuracy of the statements but the emotional tone: Ryan spoke of the former life with longing and confusion, as if caught between two identities, until the memories gradually faded around age six.

Here is an example of a case in which the child had birthmarks corresponding to the deceased person’s wounds. In rural Burma, a young boy began speaking at age three about having been a man who was shot from behind while walking along a road. His parents were startled not only by the specificity of his statements but by his two unusual birthmarks: a small, round mark on his chest and a larger, irregular one on his back. When Stevenson later investigated, he found that the boy’s descriptions matched the death of a man from a nearby village who had been killed by a close-range gunshot. Eyewitness accounts and medical documentation confirmed the wound pattern, which corresponded closely to the boy’s birthmarks. The child also showed a deep, visceral fear of guns and loud noises, reacting with panic in ways that seemed disproportionate to anything in his current environment. The case combined early and detailed verbal statements, independently verifiable information about a violent death, and physical marks on the child’s body that mirrored the trauma he described.

Stevenson’s long-term research program—and Tucker’s continuation of it—poses a direct challenge to the assumption that consciousness is wholly generated by the brain. Across more than 2,500 investigated cases, they documented young children who spontaneously described memories, behaviors, and emotional dispositions corresponding to identifiable deceased individuals. While most cases are incomplete or ambiguous, a substantial minority meet stringent evidential criteria, and more than two hundred combine multiple independent lines of evidence: verified statements, behavioral continuities, and physical correspondences. Critics have proposed cultural contamination, suggestion, fraud, or loose investigative methods, but none of these explanations plausibly account for the best-documented cases, especially those with medical records, multiple independent witnesses, and physical anomalies. Even the most skeptical reviewers have struggled to articulate a coherent alternative hypothesis that explains the full pattern of data.⁷

For more than sixty years, however, mainstream scientists have dismissed the research. Critics argue that the stories of past lives are most likely due to coincidence, misinterpretation, parental influence, observer bias, or other sources of error. They emphasize the complexities of contextualizing and translating these “memories,” especially in cultures with strong beliefs in reincarnation.⁷ Yet critics rarely engage with the case narratives themselves; instead, they rely on hypothetical sources of error. To attribute all of these cases solely to flawed methodology would require assuming that Stevenson, Tucker, and DOPS have repeatedly committed the same errors for six decades despite their detailed rebuttals of such claims.

The deeper criticism, however, is philosophical. Although surveys show that most Americans and physicians believe in a soul or spirit, most philosophers and neuroscientists endorse a materialist-reductionist view: the brain creates the mind through electrochemical activity, and consciousness ends with the death of the body. Clinically, there is ample evidence that consciousness depends on a functioning brain—brain injuries and diseases clearly alter mental states, and imaging techniques reveal neural pathways associated with various emotions and thoughts. For clinical purposes, consciousness appears entirely dependent on the physical brain.

Yet this dependence does not settle the metaphysical question of what consciousness is. Critics of Stevenson and Tucker often assume, without argument, that the physical world as described by contemporary physics is the totality of what exists, and that consciousness must therefore be a byproduct of physical interactions. But subjective experience—the interior world of personal identity—does not obviously follow from any known property of quarks, electrons, photons, neutrinos, or the forces that govern them. The gap between third-person description and first-person experience is conceptually radical. No arrangement of particles, however complex, seems to entail subjectivity, i.e. interior life, in the way that arrangements of particles entail objects, organisms, or chemical bonding. To assume that this gap will close through further study of neural circuitry is to smuggle in a metaphysical conclusion under the guise of scientific optimism.

The quantum world is exceptionally weird – in many ways it violates common sense. Particles are also waves and waves are particles. An electron can be in multiple places at once. The behavior of one particle may determine the behavior of another, even though they are too far apart for a message to pass between them. Particles can tunnel through barriers apparently without having enough energy to do so. However, none of this weirdness suggests that large accumulations of particles (e.g. atoms, molecules, brains) could generate an interior world of personal identity There must be a deeper, more complete, theory of what exists in the universe that does account for the generation of consciousness; a quantum of subjectivity, if you will. As science writer Jim Holt summarized in Why Does the World Exist?, “The properties of a complex system like the brain don’t just pop into existence from nowhere; they must derive from the properties of the system’s ultimate constituents. Those ultimate constituents must therefore have subjective features themselves.”⁸

This is why the possibility that consciousness has a fundamental place in the universe is not mystical speculation but a legitimate philosophical alternative. Some philosophers and neuroscientists propose that consciousness may be an intrinsic aspect of matter, or that the universe contains a fundamental “interior” dimension alongside its measurable exterior. Panpsychism—the view that consciousness is woven into the structure of matter—is endorsed by a small, but growing, minority of philosophers, including David Chalmers⁹, Philip Goff¹⁰, and Galen Strawson.¹¹ Another group, notably Thomas Nagel¹² and John Searle¹³, acknowledge that our current physical ontology is incomplete, although not fully endorsing panpsychism. Physics has repeatedly revised its understanding of matter; it is not unreasonable to suspect that consciousness may require a similarly deep revision. To quote Thomas Nagel, “Consciousness is the most conspicuous obstacle to a comprehensive naturalism that relies only on the resources of physical science. The existence of consciousness seems to imply that the physical description of the universe, despite its richness and explanatory power, is only part of the truth.”¹²

Given these considerations, the continuation of consciousness, at least in some form, after death seems at least a possibility. Stevenson and Tucker’s work may well represent the identification of a previously unknown natural phenomenon, perhaps analogous to reported near-death experiences — well-documented yet difficult to explain. To my mind, this conclusion is more likely than is six decades of repeated errors.

However, that doesn’t mean the “former lives” data necessarily support a traditional doctrine of reincarnation, in which a unitary soul passes from one body to another. If a psychic dimension of the cosmos exists, a one-to-one transmission of “mind-stuff” to a newborn baby in the same country and culture seems overly simplistic, more in line with supernatural beliefs than with an unknown natural phenomenon. It is notable that the phenomenon is rare and the memories transient and strongly associated with traumatic death. Could it be that, under certain conditions, a “package” of psychic impressions may transfer from a dying person to a newborn, occasionally even influencing the child’s body? This, like any other scenario, is speculative, given our ignorance of the origin and meaning of consciousness in the physical world.

The broader point is that most philosophers and neuroscientists begin with an unexamined premise: that everything real must be physical in the sense described by current physics. But consciousness—the one phenomenon we know from the inside—does not obviously fit within that framework. Before declaring that mind must be reducible to matter, we should ensure that our conception of matter is adequate to account for mind at all. Consequently, Stevenson’s and Tucker’s six-decade quest to understand the experience of children who report having lived former lives should, if anything, leave us wondering whether we really know what we think we know about the way the universe works.

References 

1. Stevenson, Ian Twenty Cases Suggestive of Reincarnation, University of Virginia Press, 1980 [First published in 1966] 
2. Schroder, Tom. Old Souls. The Scientific Evidence for Past Lives. New York, Simon & Schuster, 1999 
3. Tucker, Jim B. Ian Stevenson and Cases of the Reincarnation Type, Journal of Scientific Exploration. 2008; 22: 36-43 
4. Tucker, Jim. B. Before: Children’s Memories of Previous Lives, St. Martin’s Press, 2021 
5. Stevenson, Ian. Where Reincarnation and Biology Intersect. Westport. Praeger, 1997 
6. Stevenson, Ian. Reincarnation and Biology: A Contribution to the Etiology of Birthmarks and Birth Defects, Westport, Praeger, 1997 [Two volumes] 
7. Matlock, J. G. ‘Reincarnation Case Studies: Criticisms’. Psi Encyclopedia. London: The Society for Psychical Research. <https://psi-encyclopedia.spr.ac.uk/articles/criticisms-reincarnation-case-studies/>. (2022, retrieved 24 March 2026) 
8. Holt, Jim. Why Does the World Exist? London, W. W. Norton & Company, 2012, p. 194 
9. Chalmers, David J. The Conscious Mind: In Search of a Fundamental Theory. Oxford University Press, 1997 
10. Goff, Philip. Galileo’s Error. Foundations for a New Science of Consciousness. New York, Pantheon Books, 2019 
11. Strawson, Galen. Consciousness and Its Place in Nature, Imprint Academic, 2024 
12. Nagel, Thomas. Mind & Cosmos. New York, Oxford University Press, 2012, p. 35 
13. Searle, John. Mind: A Brief Introduction, Oxford University Press, 2005 

Web image by Medhum.org

4:48 Psychosis raises the question of what constitutes theater. Is this a case study in psychotic depression, a work of art, or both? Can one call language without boundaries a play? What direction remains for contemporary theater to take following total fragmentation?  
 

These concerns have not stood in the way of 4:48 Psychosis being produced - if anything, it seems to be gaining in popularity. What could be stumbling blocks are seen by directors as a challenge to be met creatively. The play’s initial production, at London’s Royal Court (2000) divided the words among three performers. All three initially learned the whole text, and although most lines were eventually allocated, others were voiced spontaneously by different actors from performance to performance. The “action” appeared to take place within the mind of the protagonist. Projections onto a mirror helped create a Rorschach-like effect. As evidence that the play encourages a wide variety of interpretations, in the celebrated TR Warszawa production, six actors embodied discrete characters, creating encounters between a central character and her doctor, family members, or friends. This production, brought to New York in 2014, employed a Polish translation with English surtitles.  Another production, by Theatre du Pif of Hong Kong in 2016, purported to bring “an Asian sensibility” to the play, using a Korean designer and Hong Kong musicians.”  

In conclusion, 4:48 Psychosis is clearly not everyone’s idea of entertainment (one critic likened watching it to being locked in a freezer). However, it provides a beautiful, albeit brutal, window into the depressed, suicidal mind.  

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.  

Primary Source Sarah Kane: Complete Plays 
Publisher Bloomsbury Methuen Drama 
Place Published New York 
Page Count 43 
Web Art: File:4.48 psychose.JPG – Wikimedia Commons 

Conditions change once Sweet Home’s owner dies of a stroke and his widow brings in her brother-in-law and his young nephews to help run Sweet Home; the small liberties granted to the enslaved people are revoked by the new leadership, and cruelties ensue. The enslaved people, including Halle and a man named Paul D, plot to escape north; however, Sethe and her children are the only ones who succeed in doing so, only after she is violated by the nephews and brutally whipped by the brother-in-law for informing him of the assault. These events and Sethe’s flight are complicated by her near-full-term pregnancy. Approaching death from exhaustion and exposure, she is saved by a white girl who helps Sethe give birth. Her daughter is named Denver after the contextually benevolent white girl.  

Carrying her newborn, Sethe arrives at 124, greeted by her other three children, into the care of Baby Suggs. The bittersweet happiness of her arrival without Halle is marred one month later by the arrival of a team intending to reclaim Sethe and her kids for Sweet Home. Rather than allow herself and her children to be forced back into slavery, Sethe intends to commit infanticide and suicide, succeeding in the murder of her older daughter. This action effectively prevents them from being taken, and Sethe is exonerated of her charges. Despite this, her act of desperation crushes her family, eventually leading to Baby Suggs’ death and to the flight of her sons from the household. Eighteen years later, Paul D arrives at 124. He begins a relationship with Sethe and manages to evict the poltergeist.  

Soon thereafter, a strange woman arrives by the name of Beloved, the word Sethe had engraved on her child’s tombstone. Sethe is initially unaware of the stranger’s origins, and Paul D is effectively forced out by the new arrival. Once Beloved’s identity as the deceased child is understood, she, Sethe, and Denver become wrapped up in each other, blurring the lines of their identity. Sethe loses her job, but Denver manages to extricate herself to find work. Hearing of the family’s plight at the hands of the “unholy” Beloved, thirty black women of the area band together to purge 124 of her presence. Beloved leaves without a trace. Paul D eventually returns to 124, and memories of Beloved slowly fade into oblivion. 

Beloved is a pure work of art. Toni Morrison crafted a brilliant piece fueled by the lived experiences of enslaved people’s descendants in America and informed by the temporal proximity of the ratification of thirteenth amendment. The summary outlined above fails to capture the impact of the work’s nonlinear form, both in time and perspective. Flashbacks seamlessly interweave with the driving plot. Not only are the past and present difficult to distinguish, but this intermingling also elevates the past in status compared to the present, allowing the past to rival––and often exceed––the present in narrative importance. Time becomes a unique character, one whose primary achievement is the marring of other characters’ physical beings. Through this lens, the recapitulation of Sethe’s tree scars mirrors the historical impact of slavery on the modern-day United States. This context is further validated by the work’s inspiration, the life of Margaret Garner, an African- American enslaved woman who escaped, was recaptured, and who murdered her daughter while being returned to the South. 

Toni Morrison’s mastery of figurative language builds upon the nonlinearity of the piece. Her writing is powerfully displayed through allegories, the most notable of which is found on pages 248-252. Through Beloved’s perspective, Morrison blends hell and slave ships into one entity. This same section of the novel further unifies the perspectives of Beloved, Sethe, and Denver through a mélange of emotion and perception.  

The relevance of this piece to contemporary American politics and social issues is profound and disturbing. American history continues to discredit the experiences of people of color, particularly those of who identify as Black or African-American. This novel demands that we confront the United States’ history of racial oppression. Its magical realism provides new dimension to a historical narrative, allowing for greater imaginative accessibility to the meaning behind its story. As a last powerful image, I refer to the biblically paralleled coming of the four horsemen to “reclaim” Sethe: the sheriff assumes responsibility of reinforcing the dehumanization of Sethe and “addressing” her perceived cultural, psychological, and racialized aberrancy through punishment sans reformation.  

Miscellaneous 

Beloved
Toni Morrison

Awards
National Book Award Finalist for Fiction (1987); Pulitzer Prize for Fiction (1988); American Book Award (1988); Anisfield-Wolf Book Award (1988); Frederic G. Melcher Book Award (1988)  

Publisher Vintage 
Place Published United States 
Edition 2004 
Page Count 324 

Originally published on September 16, 1987 by Alfred A. Knopf Inc. 

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

Before embarking on my project, I reviewed the literature pertaining to the use of plays in medical settings.  Friedrich Schiller, the German playwright (who was, incidentally, a physician), laid the groundwork for the use of theater as an educational tool in his 1784 essay “The Stage as a Moral Institution” calling it “a great school of practical wisdom, a guide for civil life, and a key to the mind” (Schiller, page 252).  In his view, the theatricalization of the “vices and virtues of men” and of “human woe” not only makes them more palatable, but it also actually teaches the audience to be more empathic. 

I found a wide range of milieus in which plays have been used.  In 1938, The Federal Theatre Project, a program sponsored by the WPA, produced a play entitled Spirochete with the goal of reducing the spread of syphilis (Flanagan, page 144).  More recently, dramatic narratives were used by scientists to provide a forum for learning about human genetics; these have been collected in a volume entitled The Drama of DNA.  

A pioneering program that proved inspirational to me is Medical Readers’ Theater, developed in the 1980s at East Carolina University’s Brody School of Medicine. Stories by William Carlos Williams and other doctor writers have been turned into scripts used to encourage dialogue among medical staff, students and the public about a variety of medical issues. These plays are available in anthologies accompanied by discussion questions.   

There are also numerous popular plays which are natural fits for teaching because they illustrate points of ethics, diagnosis, doctor-patient relationship, etc. at the same time as just being entertaining.  Some of the ones I have used include Wit, A Streetcar Named Desire, and Next to Normal.    

While deciding what to do for my thesis project, I was becoming quite taken with Anton Chekhov’s writing through working with Jack Coulehan at Stony Brook.  Previously, although I knew of course that Chekhov had a reputation for being one of the great playwrights, I had had the impression that his plays were a bit boring because nothing much happens in them.  What can I say?  I must just not have seen the right productions.   

I researched Chekhov’s life, read his short stories, and even plowed through Sakhalin Island, the epidemiological survey he wrote about health conditions in a penal colony. As a result, I became an admirer and gained insight into his method.  It does not matter whether there appears to be anything happening or not.  The author’s job is to record what he observes. It is not by chance that this is also the job of a physician.  One can understand why Chekhov might have wanted to continue to practice medicine even after becoming one of Russia’s most celebrated writers.  Chekhov soon became my personal role model as a doctor writer, and it felt like an honor to dedicate my time and energy to his work, and in my own extremely modest way, to add to his dramatic corpus.   

Chekhov wrote over 500 short stories, and doctors play a significant role in about 25 of them.  I chose “A Nervous Breakdown” (1889) and “A Doctor’s Visit” (1898) “for adaptation.  As “A Doctor’s Visit” has fewer characters and is the shorter of the two that is the one I use to teach.  Some students may even have read the original story already because it is so well known.   

The plot may be summarized as follows:  A doctor has been summoned away from the city to see the daughter of a factory owner, but for some reason he sends his assistant instead.  (Perhaps he just did not want to go out to the boondocks.) The assistant doctor arrives at the house and examines the young lady.  After not finding anything wrong, he concludes that he’s been called for nothing. The patient’s mother, who is depressed and overwhelmed, implores him to spend the night instead of going home to his family.  The doctor is not in a position to refuse, but he feels as if his time is being wasted and he is annoyed.  

However, in the short time he is in the factory town, the doctor gets a sense of what it is like in live in such a place. He sees how unhealthy the environment is for the workers. He sees how, despite having lavished a fortune on expensive furnishings, the inhabitants of the house are miserable. Adding insult to injury, a servant repeatedly contradicts him and gets on his nerves.  

In spite of the prejudices he has brought with him from the city, the totality of his experience makes an impression on this doctor. The next morning, he meets with the patient again. This time, he recognizes that she is a sensitive and intelligent young lady, and he now has empathy for what she must be going through. There is a moment of understanding between them. Although it does not perhaps appear as if the doctor has applied any treatment, the patient responds and shows a sense of hope.  The doctor has also changed as a result of this experience. He leaves the house and heads home in a good mood.   

Like general practitioners today, general practitioners in 19^th-century Russia undoubtedly ended up doing a good bit of psychiatry.  Although Chekhov and Freud were contemporaries, there seems to be no evidence that Chekhov was aware of Freud’s “talking cure. “  But even if not, and even if the doctor in “A Doctor’s Visit” does not think he has done anything, the doctor has in fact unwittingly administered a brief psychotherapy session.  The powerful results he obtains with such simple means remind me of some of my own experiences as a psychiatrist.  Sometimes when one uses one’s psychoanalytic theories to make what one thinks are brilliant interpretations, they fall on deaf ears.  Just being present and listening often produces the best outcomes.   

The greatest technical challenge this playwright confronted in dramatizing “A Doctor’s Visit” was figuring what to do about the doctor’s internal thoughts.  There is plenty of spoken dialogue in Chekhov’s story, and I used much of it practically verbatim.   But how to dramatize one’s inner dialogue?  It would be cumbersome to have a narrator describe it, and unnatural to have the doctor verbalize it.  My solution was to create a brand-new character, a young apprentice, someone the doctor uses to bounce ideas off.   I hope audiences and readers feel this was a reasonable compromise on my part.   

My adaptations of Chekhov’s two stories made their debut in 2015.  Since then, “A Doctor’s Visit” has been used to teach students at several medical schools:  Stony Brook, Drexel, New York University, Boston University, Cleveland Clinic, and the University of Pennsylvania.   At all but one of these I introduced the play in person, read the stage directions aloud, and led the discussion.  The text of the play is included in an appendix to this article in the hope that other schools will take it up.  And I am still available to read stage directions! 

References: 
Chekhov, Anton: “A Doctor’s Visit.”  Translated by Constance Garnett.  https://www.ibiblio.org/eldritch/ac/jr/193.h
Coulehan, Jack.  “Cold Eye, Warm Heart: Medicine and Anton Chekhov.” MedHum, October 2, 2025 Flanagan, Hallie. 1940, reprinted 1985. Arena: The Story of the Federal Theatre. New York: Limelight Editions 
Rothenberg, Karen H. and Bush, Lynn Wein. 2014. The Drama of DNA. New York: Oxford University Press 
Savitt, Todd L. (ed.) 2002.  Medical Readers’ Theater:  A Guide and Scripts.  Iowa City: University of Iowa Press 
Schiller, Friedrich. 1784. “The Stage as a Moral Institution.” In Theatre/Theory/Theatre, 250-254.  New York:  Applause 

Web image created based on this vintage illustration from WikiCommons

A Doctor’s Visit:  An Adaptation of a Short Story by Chekhov

by Guy Fredrick Glass

Downloads of this play may be distributed and performed for educational purposes only, with permission of the author.  Dr Glass may be contacted at gf***@*ol.com 

[embedpress_pdf]https://medhum.org/wp-content/uploads/2025/12/A-Doctors-Visit-2017-version-copy.pdf[/embedpress_pdf]

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/

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.