One of the most horrifying events of that year was the prisoner revolt at the Attica State Prison in upstate New York in early September. I did not live in New York at the time and have only a vague recollection of reading the newspaper reports of what happened. But ask anyone living in New York who was at least 15 years old at the time and they will tell you that they have vivid memories of what transpired over the five days from September 9-13. In this extraordinary book, Heather Ann Thompson recounts in all its gory detail the prisoner uprising, the bloody retaking of the prison by state troopers, and the nearly thirty years of investigation and legal wrangling that occurred in its wake.

By the late summer of 1971, there had been prisoner rebellions in state penitentiaries across the country including a nearby high security facility in Auburn NY. There was increasing tension and escalating prisoner protests against the inhumane conditions in all prisons including overcrowded cells, limited access to food and fresh air, and routine brutal treatment at the hands of the correction officers. Finally, Attica Prison erupted on September 9 after a minor skirmish between guards and prisoners. The prisoners took 38 hostages and over a thousand prisoners escaped their cells and crowded into the prison yard. They created a communal space to take care of each other that was equipped with meager resources. There was a central meeting area for the leaders of the uprising. They created a human shield around the hostages to protect them from harm.  

Over the next four days, there were intense negotiations between prison officials and the prisoners. A team of observers including Tom Wicker was  brought in at the request of the prisoners to serve as witnesses and act as potential mediators. Finally, after negotiations fell apart over the prisoner demand for amnesty, the troopers, without warning, dropped tear gas cannisters from helicopters and stormed the yard. Tragically, when the dust had settled, 32 prisoners and 11 hostages had been killed by bullets fired by the troopers. This terrifying sequence of events is described in the first third of the book. The remaining part details how prison wardens destroyed critical forensic evidence and collaborated with state politicians up the chain to Governor Nelson Rockefeller’s office to portray the events as a successful suppression of a radical-supported attack against the state. They solicited false testimony and pursued a one-sided prosecution of the prisoners for the murder of one guard and several prisoners. There are too many villains in the story but also some true heroes – a coroner who refused to back down from his post-mortem examination showing that all the victims were killed by gunfire, knowing that only the state troopers had firearms. The prisoners who confronted the legal system, defense lawyers willing to take up the cause of the prisoners, a brave state lawyer who was an essential whistleblower, all were vital in the pursuit of truth. At the end, the justice system failed nearly everyone involved, and Attica Prison remained an important part of the New York State correction system. The only monument is a stone at the entrance to the prison memorializing the hostages who died. 

This book is over 500 pages long. Along with another thick book, titled A Bright Shining Lie: John Paul Vann and America in Vietnam, it sat on a shelf in our apartment forever. For some reason that I cannot explain, I picked the book up recently and could not pull myself away from this intense and horrifying story. For more than a decade, Heather Thompson immersed herself in the archives and interviews with key actors in the Attica uprising story. She unearthed the bloody shirt that had been removed from two victims of the siege. Her research is evident on every page.

There are two deeply disturbing underlying themes in the book. The impact of politics and the sheer desire to retain power had a distorting influence on how the uprising was handled and how it was investigated. After watching Nixon get elected as the law-and-order candidate, Rockefeller felt compelled to take the same stance. Consequently, he refused to get involved in the negotiations or visit the prison, something that may have lowered the temperature and enabled a peaceful resolution of the siege. It is disquieting to read how many politicians and officials put self-interest and survival ahead of the pursuit of truth.   

In the immediate aftermath of the uprising, systemic changes were made to improve the well-being of the prisoners such as limits on the amount of time they could be put in solitary confinement, more time outside each day, better food, and access to legal resources. But over time, things slowly began to revert and look more like 1971 than 2021. There has been a continued growth in the number of prisons and a prison population that is larger than in any other Western country. There is disproportionate incarceration of Black and Hispanic men, often for mild offenses that would not warrant detention in a high security prison. Mistreatment of prisoners, unfortunately, is more the rule than the exception. Many explanations are offered – political positions, self-interest, and institutional inertia. But it does underscore how hard it is to make change real.  

As the country as a whole and the medical profession in particular undergo scrutiny about racist attitudes and practices, this book is a reminder that it will take an extended and concerted effort to achieve equal treatment for citizens in the penal system and in the health system. It may be easy for some to justify harsh treatment of criminals in prison or poor people living in squalid conditions. But we need to remind ourselves that a society can only be judged based on how it treats the most unfortunate within it. This applies across the board, housing, education, and healthcare.

Blood in the Water: The Attica Uprising of 1971 and its Legacy 
Heather Ann Thompson 
Miscellaneous Winner of the 2017 Pulitzer Prize in History 
Publisher Pantheon Books 
Place Published New York 
Edition 2016 
Page Count 724 

Web image by Larry Farr 

What could possibly go wrong, right? 

This is the set-up of Dorothy Bridges’ The Expendable Man, and the answer is, of course, “plenty.” It is not a big reveal to say that the girl’s motives seem dubious, and she proves hard to be rid of, being dropped off and then repeatedly showing up again, including at Hugh’s Phoenix motel room, where he refuses to speak to her. It is not even a big reveal to say that the morning after she shows up at his motel room her body is found in a canal on the outskirts of Phoenix, and the autopsy reveals her to have been pregnant—and to have had an abortion. Unsurprisingly, the suspicion of the local police falls on Hugh, the last person—and conveniently, a physician—known to have seen her alive. It will be up to Hugh to prove his innocence despite the damning circumstances.  

Dorothy Hughes was known as a writer of noir fiction, and The Expendable Man is no exception. From the first page she creates a sense of uneasiness which pervades the entire novel. The dry airless heat of the southwestern desert, the rowdy and vaguely threatening teenagers in their jalopies who buzz about the town of Indio like so many flies, the trackless expanse of territory with the lone hitchhiker in the middle of nowhere, the local police, who seem to have had their humanity burned out by the heat—all of this contributes to the subtle but steadily mounting dread which characterizes so much of the novel.  

The book was written in 1963, when Los Angeles was very much the land of dreams, and Phoenix was still a relatively young and underdeveloped city just beginning to stretch out in the Maricopa Valley; it’s a short distance from the downtown neighborhoods to farms and empty lands where bad things can happen. And when this particular bad thing happens, people want to find the perpetrator. If it could possibly be an outsider, someone educated and from the big city, who drives a big Cadillac—someone “not one of us”—so much the better. Of course it looks too easy, but the community needs someone to blame. They need a sacrifice, and Hugh is just that: convicting him of the crime will spare the police having to look too hard in their own backyard for the culprit. Hugh is literally an expendable man. 

Fortunately, Hugh has his family and his new love interest to support him, and he enlists them in his attempt to solve the crime, because solving the crime is the only way to get him off the hot seat. How this happens is well-plotted and holds the reader’s attention.  

The fact that this is written in 1963 influences the lens through which the novel should be read; that is, with mid-twentieth-century mores and cultural referents in mind. Reaction to the news that the dead girl has had an abortion galvanizes the community—abortion is illegal, and the Arizona of the novel considers it immoral as well. The combination of people’s revulsion at the very fact of the abortion, and the thirst for punishment that accompanies it, magnifies the crime of murder; everyone talks about the heinous nature of what has happened. Also, the Cadillac was at the time a symbol of having “arrived,” and a medical school education was expensive; not all families could afford to pay for one. And golf was, and still is, an expensive indulgence. With touches like these Hughes paints a very specific picture of her protagonist.  

The Expendable Man is, however, so much more than simply a mystery. Hughes’ ability to create the setting and build the uneasiness is superb literary craft. Interestingly, it’s possible that the way she does this has partly to do with her excellent writing and partly to do with popular culture that postdated the novel’s publication—i.e., it may have as much to do with what the reader brings to the novel as (or rather, in addition to) what the author puts in it. Every film that included a hitchhiker story gone bad—and there are any number of them—contributes to the aura of dread in the early pages. And it is hard to read the descriptions of the action in Phoenix without channeling the early parts of Hitchcock’s Psycho. And we all know how that turned out.  

But The Expendable Man is also the novel as social commentary, never directly stated, but always there. The conflict between the middle- or upper-middle-class, cultured, educated, “city slicker” and the locals who think and live very differently—and are looking to hang someone—is riveting.  

There is one big reveal which comes out of left field. It happens relatively early on and changes everything in the way the reader views the story. It’s actually too good, too cleverly imagined, to give away, but watch for it (it’ll be hard to miss) and prepare to have everything you’ve thought about the story suddenly change with the breathless rapidity of a pulled-out rug. It will ratchet up the discomfort and make you re-evaluate the entire story and your reactions to it. 

Don’t say you haven’t been warned.  

The Expendable Man 
Dorothy B. Hughes 
New York, NYRB Classics, 2012 (orig published 1963), 264 pp. 

Web image by Medhum.org

Esther, daughter of a native healer who has some familiarity with and respect for Western medicine, envies and longs for Antonia’s Western training and attaches herself to her as a disciple. In her encounters with patients, Esther finds that she has an inexplicable gift for healing which baffles her as well as Antonia and complicates their already tenuous relationship. Esther’s gift forces Antonia to reexamine some of her most basic assumptions about what constitutes healing. 

The novel raises complex questions about the cultural, religious, and institutional contexts of medicine in a delicately drawn portrayal of relationships among characters whose divergent frames of reference complicate trust and understanding. One of the questions the novel addresses is not only how to heal the body, but how to heal the breach between cultures. In the development of the friendship between the American doctor and the African healer these questions are worked out in concrete particulars that fully honor both the pain and the hope involved in authentic cross-cultural dialogue. 

Antonia Saw the Oryx First
Maria Thomas 
Soho Press, New York 2007: 296 pages 

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

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Soto explores his uncertain status in relation to his family, and to the larger society in “You’ve Gone Too Far.” Detailing the “evolution” of his siblings and cousins, who “were no longer Mexican rednecks,” but “held down jobs” and “stopped jamming parking meters for free time,” Soto describes how his family nevertheless feels uncomfortable about him. “My family feared that I had evolved too far.” Drunken Christmas horseplay with his brothers reveals their distaste and distrust of his intellectualism and sophisticated clothes. “They tore my book in half, / and stripped me of my Italian belt.” Only when they have succeeded in making him sick/drunk do they accept him (at least temporarily) back into the family fold. The poem illustrates well the difficulties that can arise when one member of a family elects to live life differently from the rest yet wants to maintain a relationship with its members. The situation has resonance for the children of immigrants, for children who are more educated than their parents, or for anyone who has chosen a life unfamiliar to family or friends.  

“TV in Black and White” focuses on the role of television (in the 1950s/1960s) in shaping, reflecting, and failing to reflect American society. Soto remembers his childhood in which “[we] were sentenced to watch / the rich on TV …”. Sitcom characters played golf, ate steak, and dressed fashionably (the Donna Reed Show, Ozzie and Harriet). “While he swung / we hoed / Fields flagged with cotton . . .”  

Now life is for many relatively luxurious, “Piano lessons for this child, / Braces for that one — “ “But if the electricity / fails in this town, / a storefront might / be smashed /” “and if someone steps out / with a black-and-white TV, / it’s because we love you Donna, / we miss you Ozzie.”  

Soto’s critique is still relevant today. The ubiquity of television and streaming, even in low-income households, confers enormous power on the images and narratives presented. Now there are many more options for viewers of different cultural and economic backgrounds. Yet the dominant culture still exerts a major influence. The gap between representation and reality continues to be an important source of social dissatisfaction and unrest. 

Gary Soto 
https://garysoto.com/
https://www.poetryfoundation.org/poets/gary-soto#tab-poems

Mexicans Begin Jogging
Online: https://www.zocalopublicsquare.org/by-gary-soto/  
New and Selected Poems, Chronicle Books, San Francisco, 1995, p. 51

You’ve Gone Too Far 
Published in Junior College, Chronicle Books, San Francisco, 1997, p.24

TV in Black and White 
New and Selected Poems, Chronicle Books, San Francisco, 1995, p.50

Web image by Jr Korpa 

In this poem of high irony, 21 stanzas of couplets brilliantly spin out stereotypes of Indigenous people promulgated by white American culture. Among the stereotypes that Alexie develops: the tragic Indian; Indian women as sexual objects for white men; Indian men secretly desirable to white women; Indians as violent, alcoholic, childlike, mystical,” and members of a “horse culture.” But in addition, Alexie emphasizes how American whites have co-opted Indian culture: “white people must carry an Indian deep inside themselves” until finally, “all of the white people will be Indians and all of the Indians will be ghosts.” The poem is a painful reminder of how the United States has at one and the same time decimated indigenous people and their culture while exploiting those people and that culture for its own gain. It is a commentary on stereotyping, loss of identity, and loss of a people.

Sherman Alexie is a poet, novelist, short story writer, essayist, and film writer. He is a Spokane/Coeur d’Alene Indigenous person and grew up on a reservation in Washington state. His work focuses on relationships between Indigenous people and white Americans and on life within a white power structure. Alexie’s writing is consistently humorous and ironic.

How to Write the Great American Indian Novel
Sherman Alexie
https://fallsapart.com

Source The Summer of Black Widows, pp. 94-95
Publisher Hanging Loose Press
Edition 1996
Place Published Brooklyn, New York
Alternate Source Native American Songs and Poems, pp. 28-29
Alternate Publisher Dover Thrift Editions
Alternate Edition 1996
Alternate Editors Brian Swann
Place Published New York

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

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On the one hand, if the doctor is physically unable to treat, then he is not responsible for withholding treatment. On the other hand, by being rendered professionally helpless, perhaps he is being punished for not taking a moral stance against his patient. This interpretation seems to have validity because the last line recalls Psalm 137, which warns, “If I forget thee O Jerusalem, let my right hand forget her cunning.” 

For drawing attention to the biblical reference, I am grateful to Dr. Danielle Ofri (clinical professor) and Lara DeLong (Class of 2001), both at NYU School of Medicine. Dannie Abse (1923-2014) was a practicing physician and poet. 

Reading by Dannie Abse

Case History
‘Most Welshmen are worthless,
an inferior breed, doctor.’
He did not know I was Welsh.
Then he praised the architects
of the German death-camps–
did not know I was a Jew.
He called liberals, ‘White blacks’,
and continued to invent curses.

When I palpated his liver
I felt the soft liver of Goering;
when I lifted my stethoscope
I heard the heartbeats of Himmler;
when I read his encephalograph
I thought, ‘Sieg heil, mein Fuhrer.’

In the clinic’s dispensary
red berry of black bryony,
cowbane, deadly nightshade, deathcap.
Yet I prescribed for him
as if he were my brother.

Later that night I must have slept
on my arm: momentarily
my right hand lost its cunning.

Commentary

“Sometimes it’s very difficult to like some patients. Patients imagine that they’re always likable, but in fact there are some one has great difficulty with, I think. And indeed there was one patient that bugged me so sufficiently that I wrote two poems about him.”

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

The Knick portrays all that goes on in and around a hospital struggling to provide care for the poorer classes in lower Manhattan during the early 1900s. It shows that many of what were then considered important advances in medicine, technology, society, and culture were later considered dangerous, unethical, barbaric, inhumane, and racist. The series asks whether health care of any era, along with associated social and cultural factors at work, are destined to be seen sometime in the future in similar ways. 

Storylines of the Poor and the Famous 

The Knick was inspired by the Knickerbocker Hospital, founded in Harlem in 1862 to serve the poor. In this twenty-part television series spread over two seasons, the fictional Knick is located somewhere in the lower half of Manhattan around 1900. The time covered during the series is not marked in any distinct way. The characters do not age much, and although fashion and customs remain static during the series, the scope and significance of advancements that come into play were actually adopted over a longer time than the episodes cover.  

The series builds on some known history. The central character, the chief surgeon Dr. John Thackery, is modeled on a famous surgeon of the time, Dr. William Halsted, in both his surgical adventurism and in his drug addictions. The character, Dr. Algernon Edwards, who is an African-American, Harvard-educated, and European-trained surgeon, is based in part on Dr. Louis T. Wright, who became the first African-American surgeon at Harlem Hospital during the first half of the twentieth century.   

Storylines of human drama and folly run through the series. Among them are medical cases both ordinary and bizarre, heroic successes and catastrophic failures, loves won and lost, gilded lives and wretched existences, honor and corruption, racism and more racism. Within these storylines are the scientific, medical, and industrial advances of the period, as well as the social frameworks that form fin de siècle hospital care and medical research in New York City.   

Some of the industrial advances adopted by the hospital include electrification, telephone service, and electric-powered ambulances. We see that transitions to these new technologies are not without risks and catastrophes: patients and hospital staff are electrocuted, and when the ambulance batteries died — a frequent occurrence– many of the patients they carried died, too. 

Medical advances integrated into various episodes include x-rays, electric-powered suction devices, and an inflatable balloon for intrauterine compression to stop hemorrhages. Thackery is a driven researcher taking on some of the big problems of the day, such as making blood transfusions safe, curing syphilis, and discovering the physiologic mechanisms of drug addiction. We see how he learns at the cost of his patients, or rather his subjects. We also get a glimpse of movements directed at population health. For example, epidemiological methods are applied to find the source of a typhoid outbreak, which drew from the actual case of Mary Mallon (aka, Typhoid Mary). Shown juxtaposed to the advances in epidemiology is the concurrent interest that was rising in eugenics and its broad application to control for unwanted individual traits and particular groups of people. Research ethics and regulations were a long way off.  

Time Tells 

Each era possesses its own hubris based on the technological advances and social progress made over those of previous eras, and on the certainty that the mistakes made before have not been repeated. Time reveals whether those attitudes and positions were justified. For Soderbergh, the director of the series, this idea was top of mind, and he stated as much in an interview published in the August 1, 2014 New York Times:  

There are so many treatments on the show that make you gasp because they’re so wrong…It just makes you wonder what treatments we’re all taking at face value that 10 or 15 years from now we’re going to be told, ‘Well, that didn’t work, and in fact that makes it worse.’  

Early twenty-first-century medical care has benefited from advances in molecular biology, medical devices, surgical procedures, data analytics, and epidemiological methods among others. People only participate in experimental protocols with their informed consent, and health care workforces are highly diverse. Impressive indeed, but none that in any way dwarf some of the advances shown during the series, and many that make twenty-first-century medical care possible. And, while The Knick shows how patients were often victims of bad science, bad technique, unproven technology, and malfeasance, the current era of health care is rife with risks for its own harms. Based on a complex analysis from several sources, the U.S. Institute of Medicine estimated in 1999 that between 44,000 and 98,000 people die from preventable medical errors each year in the US (To Err is Human). In 2016, researchers from The Johns Hopkins University reported in the May 3, 2016 issue of The BMJ (The British Medical Journal), that at the time The Knick was running in 2014–2015, medical errors were the third leading cause of death in the U.S. While the the accuracy of these estimates could be challenged, we can take from them with some amount of certainty that medical error exists today to a significant degree.  

The Knick pushes us to consider and to beware of what we may see resulting from modern-day biomedical and technological advances as time passes. To the medical drama and personal drama of most television medical serious, The Knick adds the drama of time. 

—————————- 

The Knick
Steven Soderberg, director 
Cinemax 
Twenty episodes, 2014-2015 
Running time: 42–57 minute episodes 

Awards
Peabody Award 
Six Primetime Emmys 
Three Critics Choice Television awards 

The Knick began streaming on HBO Max on February 20, 2021 

The action in James, which is told in the first person, follows a good part of Twain’s story line. James, a slave, overhears that he is to be sold to a man in New Orleans and separated from his wife and family, so he flees his owner’s home and hides on a small island in the Mississippi River to buy time and plan. Meanwhile, Huck’s father, a violent alcoholic, has returned to town, and to get away from him, Huck has faked his own death, has run away from home, and is also sheltering on the same island. Together Huck and James flee down the Mississippi on a raft. With Huck thought to be dead and the runaway James presumed to be his killer, James realizes that Huck’s safety and survival are the only proofs of his innocence.   

Many of the episodes of Twain’s novel are here, but when James and Huck become separated, James’s independent narrative begins. He is left in the service of a blacksmith, where his singing attracts the attention of a leader of a minstrel troupe, who purchases him. But to perform, James must first be made up as a white man and then wear blackface. The troupe also contains a light-skinned black man passing as white, who befriends James and runs away with him. They wind up on a crowded riverboat and James discovers that Huck is on the same boat. The ship’s boiler explodes, the ship capsizes, and James must decide to save either his friend or Huck. He saves Huck (there are multiple reasons for this) and then sets about trying to return home to find his family and get them to safety…and freedom. 

James is often funny, but it is not light. Separation of families, whippings, and killings are presented as the backdrop to daily life—which renders them even more horrible. However, Everett is not just interested in retelling the Huck Finn story from another character’s viewpoint; he is interested in telling a different story: James’s. Turning the racial dynamic upside down, Everett’s slaves speak perfect English among themselves, but purposely revert to deep stereotypical dialect when around white people. They understand that by code-switching in this way they are giving the whites what they want and expect; to do otherwise would challenge the rigid social hierarchy and thus put the slaves in grave danger. Their use of dialect keeps them relatively safe, and importantly, helps them maintain a kind of control of the situation. When you have so little, a secret is a powerful thing. 

For much of the book is about power. There is a wonderful scene early in the novel where James is holding a class for slave children in which he drills them on the way they must speak around whites: 

“White folks expect us to sound a certain way, and it can only help if we don’t disappoint them,” I said. “The only ones who suffer when they are made to feel inferior is us. Perhaps I should say when they don’t feel ‘superior.’ So, let’s pause to review some of the basics.” 

The children then proceed to enumerate the rules: don’t make eye contact, never speak first, never address any subject directly when talking to another slave. The correct way to report a fire in the kitchen is not “Fire, fire!”, but “Lawdy, missum! Looky dere.”—because “…we must let the whites be the ones who name the trouble.” In this and other sections Everett lets us peek behind a curtain to see Black resistance in action. He also makes us see beyond Twain’s literary stereotype to understand the enslaved Black characters as fully formed people: aware, articulate, clever, and possessed of deep emotional lives, creators of a complex society within the general society of the time and place. Everett isn’t interested in the myth of the long-suffering, infinitely patient, preternaturally wise servant, except to explode it.  

James suggests that it is the control of the tools of the intellect—primarily spoken language (though James can read and write as well)—that is ultimately the slaves’ power and their defense. Denying the enslaved an education was, of course, a way of keeping them down, and many in the South fought hard to maintain this status quo. James’s treasured possessions are a book, a notebook, and a pencil, and the code-switching mentioned above is not merely a defense, but a way in which white masters can be manipulated.  

Besides education, Everett explores another source of power (or its lack): skin color, its implications and, despite the rigid social system, its malleability. Beyond the primary black/white power implications of the antebellum South, we have in the minstrel performance section white men in blackface, a black man “passing” as white who dons blackface, and a black man who must be made up to look white before he can put on blackface. There is even a biracial character in the novel, who shows up so unexpectedly that the reader is left to wonder about the author’s motivation here; is he saying this is far more common than anyone thought? Is he sending up the Great American Novel? Saying that the black and white roots of American history—and literature— are more inextricably commingled than we could imagine? Everett doesn’t expound on this but leaves us to hypothesize. 

 Perhaps the most obvious signifier of power in the novel is in the title. The protagonist is not James, the name the white world—his enslaver—calls him. but James, the name he chooses for himself. At one point he is told to identify himself:  

He is not someone’s property, no longer to be identified by a name someone else has given him. He has chosen this name, and the ability to name (see the children’s discussion above) is a power in itself. 

James is brilliant, clever, eminently readable, a tale of personal victory and an emotionally rich yet biting commentary on the dynamics of race relations. It is also grimly serious in its portrayal of the horrors of daily life for enslaved people in the antebellum South. Everett starts with Twain’s work and takes it in another direction, with another voice heard from. James’s intelligence, humanity, and determination run through the entire novel; in Everett’s telling, James is not simply Huck’s long-suffering sidekick, the good loyal companion who is ultimately liberated—literally—by Huck and Tom Sawyer. James has his own agenda, and though he may be bought and sold, he is at no time a pawn. He is hyperaware of his situation and always searching for a way to accomplish his ends; he has agency. Near the novel’s end we even have a Biblical moment where James brings down a cataclysm upon his enslavers and leads his people to freedom.  

A retelling of Huckleberry Finn, indeed. 

James is shortlisted for the 2024 Booker Prize. Nonso Anozie reads an excerpt:

James
Percival Everett 
Doubleday, New York
320 pp (hardcover) 

Feature image by Guille Pozzi

It seems as if there is a man named Benjamin Rush who follows me everywhere I go.  He was one of the founding professors at the medical school I attended.   He was on the staff of the hospital where I did my training.  He was one of the initial fellows of the College of Physicians of Philadelphia where I’m now a fellow, and where a medicinal plant garden now bears his name.   He appears on the seal of my professional organization, the American Psychiatric Association.   At one point, apparently, he even came within spitting distance of my future home when he made the famous crossing of the Delaware River along with Washington and the troops. 

But who was this person, really?  That is what I was wondering when I picked up Stephen Fried’s biography Rush. He seems to have known everyone who was anyone, yet Rush himself is one of the least well-known of our country’s Founding Fathers.  It turns out that the answers are complicated. 

Rush has been called the father of American Psychiatry.   When he began to work at Pennsylvania Hospital, he was appalled to discover the “lunatics” chained up and below ground in unheated cells, receiving no treatment.   The public could come in and gape at them for four pence.  Although Rush made wide-ranging contributions to medicine in his long career as a physician (such as guiding Philadelphia through a series of yellow fever epidemics), he returned repeatedly to the problem of the patients in the basement.    

In an era when madness was frequently seen as a moral failing, Rush put forth the theory that it was a disease.  (He believed that about alcoholism too.)  He spoke to the mentally ill like human beings, and when they had delusions, which he called “errors of thinking” (Fried, 2018, p.269), even tried to understand them.  He banished the public from the basement, had heaters installed in the cells, and petitioned the hospital to supply the patients with “exercize and amusements” (Fried, 2018, p.450).  Although Rush wrote prolifically throughout his career, he finally published his magnum opus on the subject just a few months before his death. In Medical Inquiries and Observations, upon the Diseases of the Mind, he sought to bring mental diseases “to the level of all the other diseases of the human body…. Time I hope will do my Opinions justice.  I believe them to be true and calculated to lessen some of the greatest evils of human life.” (Fried,2018, p.469)  

All of this is admirable.  However, the other side of the coin is that some of Rush’s treatment methods were questionable.  True, he was far from being the only physician at the time to use bloodletting for…just about anything and everything.  However, even among his contemporaries, he was known as being so aggressive a bloodletter he was parodied as Doctor Sangrado (a reference to an evil physician in a popular novel who bled patient dry).  He also comes off, at least in Fried’s book, as having as a character flaw an inability to ever admit he was wrong.  So, in defiance of his detractors he persisted in using bloodletting to the end of his career.  And although his recommendations about diet and exercise were indisputably helpful ones, his Tranquilizing Chair and Gyrator (they sound like rides in an amusement park, but probably weren’t very amusing) did not turn out to be.   

In addition to his stubbornness, Rush had a tendency to say things that perhaps he might have thought out more carefully.  He never lived down a foolish criticism he had made of George Washington. He made outrageous pronouncements as a physician based solely on observation.  In what Fried calls “the most spectacularly wrong-headed address of Rush’s career” (Fried, p. 389), he conjectured that the dark skin of black people comes from leprosy. A man of profound contradictions, Rush was an abolitionist who also turns out to have been a slaveowner. While this may not have been unheard of in the 18^th century, it is disturbing today considering some of his statements.  In 2021 The New York Times published an article entitled “Psychiatry Confronts its Racist Past, and Tries to Make Amends” which sees Rush’s leprosy theory as one source of the structural racism in psychiatry that has led to the pathologization of African Americans for hundreds of years.  

Back in 1894, when the American Psychiatric Association unveiled its official seal, it included a likeness of Benjamin Rush’s profile: “The choice of Rush…for the seal reflects his place in history…Rush’s practice of psychiatry was based on bleeding, purging, and the use of the tranquilizer chair and gyrator.  By 1844 these practices were considered erroneous and abandoned.  Rush, however, was the first American to study mental disorder in a systematic manner, and he is considered the father of American Psychiatry.” But today, Rush is evidently no longer considered to be a role model. in 2015, the APA adopted an entirely new logo that did away with Rush altogether, although the organization would “continue to use the seal…for ceremonial purposes and for some internal documents.”  (“American Psychiatric Association,” Wikipedia)  

In conclusion, although we can not necessarily hold historical figures to task for making comments that were considered acceptable at the time, we also need not put them on a pedestal.  Fried’s book Rush depicts its subject as a brilliant man with weaknesses.  The more I read about Rush, the more interesting and complex I find him to be.   

References  
Fried, Stephen. Rush. New York, Broadway Books, 2018 
Warner, Judith. “Psychiatry Confronts its Racist Past, and Tries to Make Amends.” The New York Times, April 30, 2021 (updated May 21, 2021) 
“American Psychiatric Association,” Wikipedia, updated July 3, 2024

Paul Harding uses this disquieting episode as the basis for his latest novel, The Other Eden. Harding is the author of Tinkers, his debut novel which was published in 2009 by Bellevue Literary Press. That book was awarded the Pulitzer Prize, a unique achievement for a book that had been published well outside of the mainstream. His setting is called Apple Island, and the founders are Benjamin Honey, a freed slave, and his Irish wife Patience Raferty who arrive on the island in 1792. They survive a monstrous storm and flood in 1815 and together with a handful of families build a community that over the next 100 years is able to endure and thrive in the face of the harsh elements that confront them.

The descendants of the Honeys are the most prominent characters in Harding’s narrative. The current matriarch, Esther, spends most of her time brooding in a rocking chair, keeping watch over her family, and vigilantly guarding a secret about her son, Eha. Eha is a carpenter, who partners with another resident on the island to build all of the homes for the residents; this partner is an older man who lives alone sheltered inside a hollowed-out tree and who has carved an intricate circular mural that coils upward along the trunk of his home.  Ethan, Eha’s 15-year old son, is a precociously talented artist who is alert to nature and his surroundings and constantly putting images to paper. His two younger sisters are always on the go and playing with the children of three other families.

The outside world intervenes in this quiet secluded world when a team of officials from the neighboring town of Foxden on the coast comes to Apple Island with a mission — to investigate the health and well-being of the inhabitants. They are primed by an entrenched belief that there are certain people in society who are innately better and the consequent dangers of mixing races and inbreeding over several generations. With this in mind, the town representatives conclude that it is in the best interest of all concerned to condemn the Apple Island village and disperse its inhabitants. This is the only solution that they believe will prevent future generations from being adversely affected by the downward spiral of human intellectual and moral capacity and that will avoid the spread of this social contagion beyond the confines of the island. Interwoven with this depressing storyline, there is an effort by a local minister to rescue Ethan from Apple Island because he is very fair-skinned. He may be able to pass as White and his artistic talent may enable him to overcome his “flawed” racial beginnings. Needless to say, the path to a tragic ending is patiently laid out by the author. But Harding’s genius is to make us appreciate the deep humanity and abiding love that the inhabitants of Apple Island sustain even though they cannot escape the colony’s ultimate demise.

A plot summary cannot do justice to the beauty and power of Harding’s prose. His principal characters are simple people living  a subsistence existence. But they are embedded in a lushly evoked environment, and they are attuned to the rhythms of nature and the cycles of daily human life. The emotions are deeply felt, and the action rings true; the inhabitants of the island are not cardboard heroes or angels. There is a threat of violence lurking just below the surface that can emerge with shattering force when triggered by unexpected events.

Ethan’s story is presented as a complex mixture of personalities and motivations. The minister who comes to Apple Island to tutor the children and who devises the plan to rescue Ethan from life on the island recognizes the remarkable native intelligence of his school-age pupils, one who is literate in Latin, another who has mastered geometry. But he painfully admits in his private journal to deep feelings of revulsion when he is surrounded by the black and mixed race children in school. When Ethan is relocated to the home of a wealthy family on the mainland to continue his art education, he becomes more than friends  with one of the servant girls, Bridget. There is a familiar element to their story, but the last stage is surprising and moving in its depiction of devotion and steadfastness in the face of love and separation. Ethan’s fate is mysterious, but his drawings live on in museum exhibitions.

The underlying motivations of the mainlanders who come to survey the living conditions of the people on Apple Island are clothed in their seemingly noble aspiration of improving the lot of humanity.  They use the language of social Darwinism to defend their eugenics agenda, and this is no simple literary plotline. The eugenics movement in the United States was widespread and widely accepted; the nation became obsessed with the concept of “fitter families” and the dangers of reproduction of the unfit, and over 60,000 “feeble minded” individuals were involuntarily sterilized in early twentieth century America. The horrible consequences of flawed science and mistaken beliefs about biology and intrinsic human worth are made abundantly clear. But Harding’s writing rises above formulaic condemnation or pedantic instruction to the reader. He makes you live the experience and the suffering of the islanders whose humanity is so grossly ignored by the team of experts sent to learn about them and then deal with them.

Many reviewers of The Other Eden have commented on the mythic nature of the book. I think they sell Harding short. I think his accomplishment is far greater. His writing is almost Biblical in nature,  in the sense that Marilynne Robinson describes biblical writing in her recent book Understanding Genesis (Farrar, Strauss, and Giroux, 2024). In that work, Robinson marvels at how all of the events that unfold in Genesis occur under divine guidance and plans, yet  the men and women maintain their independence to act and influence their fate. God and  humankind are in a covenantal relationship. Each has the capacity to surprise, to rise above their circumstances, defy expectations and even act out of love and forbearance when circumstances might dictate revenge and retribution. Similarly, Harding’s literary world is infused with the powerful belief in human agency and decency, concepts in direct counterpoint to the biologic determinism to which the mainlanders subscribe

The Other Eden evokes many Biblical narratives and themes. Apple Island grows out of a flood and the inhabitants are dispersed after the decision is made to end the colony. There is demonic evil and the threat of servitude, with the image of an enslaving Pharaoh lurking over the heads of the investigators from Foxden. There is branding at birth, deception of elders, scheming to save a favored child, and banishment of a disgraced woman. Noah, Abraham, Jacob, Moses, Pharoah, and Ruth are hovering over the residents of Apple Island. Harding uses all of these archetypal tropes and personalities. But like all good Biblical narratives, the images serve to construct a human world that speaks to all of us. The Other Eden is more than a foundation myth. It is a chronicle of living.

THIS OTHER EDEN
Paul Harding
W.W. Norton and Co.
2023
221 pp (paperback)

Web Photo by Seth Dewey