recovery – medhum.org

Rethinking Mental Illness: Interview with Dr. Gavin Francis

Rudy Malcom — Tue, 14 Jul 2026 14:08:43 +0000

The Physician on His New Book, The Unfragile Mind
In 1999, the pharmaceutical company SmithKline Beecham launched a major advertising campaign for its antidepressant Paxil, helping to popularize the diagnosis of “social phobia,” now known as social anxiety disorder. With the slogan “Imagine Being Allergic to People,” severe shyness was reframed as a psychiatric condition.

“In a remarkably short time this new diagnosis entered the textbooks as if it had a discrete, biological reality, rather than simply the rebranding of a very common trait,” writes Dr. Gavin Francis, a Scottish general practitioner, in his latest book, The Unfragile Mind: Making Sense of Mental Health.

“As a culture we have a mania for categorising mild to moderate mental and emotional distress as a necessarily clinical problem,” he continues, noting that outside of the West, depression, anxiety, and delusions are often understood in spiritual or religious terms.

He questions the undue faith that many patients and doctors place in the cast-iron categories of the Diagnostic and Statistical Manual of Mental Disorders, the so-called “bible” of psychiatry, arguing for a more dynamic approach grounded in relationships.

The book chronicles the history of psychiatry from the ancient Egyptians, who linked mental suffering to bowel disorders, through the ancient Greeks and Romans, whose humoral theory dominated Western medicine for nearly two millennia, to the present day. Francis also weaves together colleagues’ wisdom with his own work and experience.

“Every mental health problem I see in clinic has at its core a tendency that, in a more measured dose, or different context, could contribute to human well-being, rather than detract from it,” he writes. “If we were able to hold the labels more lightly, aware of the human tendencies they oversimplify, would we be able to create a society more accepting of difference? Might it be less stigmatising, but also more hopeful, and more open to recovery?”

The following interview has been edited for length and clarity.

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?

Dr. Gavin Francis

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.

Bibliophobia by Sarah Chihaya

Guy Glass — Tue, 30 Sep 2025 18:11:35 +0000

As Bibliophobia begins, author Sarah Chihaya has had a “nervous breakdown” and is in a hospital. Although she attempted suicide three times between the ages of 10 to 18, her depression has been more or less under control as an adult. But now she has been warned she will lose her job as a professor of literature if she does not produce an academic book, and the deadline has passed. She cannot take it anymore.

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.

The Tennis Partner by Abraham Verghese

Dave Hsu — Tue, 10 Jun 2025 14:04:21 +0000

Sports Literati X Apollo On Call

This month, on Apollo On Call, we have a special collaboration podcast to share with you. My guest co-host for this episode is Dr. Dave Bryant. We usually meet up to podcast about sports books on the Sports Literati podcast. But this month, I managed to find a sports book that deals with medical humanities that is perfect collaboration material!

The Tennis Partner is a 1998 memoir by Abraham Verghese that talks about his friendship with a troubled former professional tennis player turned medical trainee named David Smith. At the time, Verghese was an infectious disease specialist in El Paso, Texas, where David was a medical student.  Verghese’s marriage was also coming apart at the seams. Into this void enters David. Determined to test his own tennis skills against a former pro, Abraham ends up befriending David over tennis and the two become close friends. As their lives unravel, we get a multi-layered story about friendship, medicine and tennis.

Have a listen and let us know what you think! And if you are interested in more sports booksdiscussions, check us out on the Sports Literati podcast.

TRANSCRIPT FROM THIS EPISODE

Dr. Osler and His Irascible Patient

Jack Coulehan — Thu, 02 Jan 2025 16:20:06 +0000

On June 15, 1888, the following notice appeared on page 5 of the New York Times under the headline AGED POET SUFFERS RELAPSE:

“Prof. William Osler, of the University of Pennsylvania, was summoned by telegraph this afternoon to go to Walt Whitman’s bedside. The aged poet had a relapse, and it was feared that he was dying. When the doctor came away from the little frame house at 328 Mickle Street, Camden, at 8 o’clock tonight, he said the poet was resting easily and about holding his own.”

Osler first visited Whitman in 1884, shortly after moving to Philadelphia to take up his position as Professor of Medicine at the University of Pennsylvania. Dr. Maurice Bucke, a Canadian psychiatrist and mutual friend, had asked Osler to look in on Whitman, who was complaining of dizzy spells and fatigue. The professor obligingly ferried across the Delaware River to Camden and made a house call. Osler reported that the poet had no residual neurological deficits from his earlier stroke. He was unimpressed with Whitman’s current symptoms and, in fact, later described him as “a fine figure of a man who had aged beautifully, or more properly speaking, majestically with a large frame and a well-shaped, well-poised head…“ ¹^{, p. 21}

Walt Whitman

However, four years later the situation was more serious. On June 14, 1888, Whitman developed slurred speech, prostration, and confusion “such as we know are not uncommon with sclerosis of the arteries of the brain.”¹^{, p.}¹⁷⁸ When Osler was called in, he recommended general supportive care and issued a cautiously optimistic prognosis (as the Times reported), but evidently did not present his patient with a specific diagnosis or discuss pathophysiology. Whitman recovered over the following weeks, but his health gradually deteriorated over the next several years until his death in 1892.

During the years Osler served as the poet’s primary care physician, their relationship was respectful, but not ideal. Whitman frequently complained about the great clinician’s rosy bedside manner. “Osler made light of my condition,” the poet wrote. “I don’t like his pooh-poohs. The professional air of the doctor grates on me.” ¹^{, p.}⁵⁰ On another occasion he told his friend Horace Traubel, “I confess I do not wholly like or credit what he (Osler) says. I do not fancy the jaunty way in which he seems inclined to dismiss my troubles.” ²^{, July 3, 1888} Evidently, Osler continued to speak in generalities, rather than addressing specific concerns that Whitman raised as he became progressively feebler.

This situation contrasts with some of the poet’s earlier medical experience. For example, shortly after his stroke in 1873, Whitman consulted Dr. Mathew Grier who must have explained the etiology of the problem. Whitman later wrote to his friend Peter Doyle, “Did I tell you that Dr. Grier here says that my real disease is the brain not being properly furnished and nourished with blood…” ³The poet’s other physicians included Drs. Silas Weir Mitchell and his son John Kearsley Mitchell. The famous neurologist and champion of neurasthenia made house calls on Whitman twice in 1878 when the poet reported symptoms of rheumatism and prostration, which he had self-diagnosed as a recurrence of his previous stroke. Mitchell assured him that the stroke, which had resulted from a ruptured blood vessel in the brain, was not responsible for the current symptoms. These, Mitchell claimed, were caused by chronic stress, perhaps exacerbated by anxiety over a public lecture that the poet was just then preparing to give.³ In other words Mitchell considered the illness a manifestation of neurasthenia. He prescribed travel, mountain air, and vigorous outdoor activity, which was Mitchell’s generic regimen for neurasthenia in males, quite the opposite of his more famous regimen of complete bed rest for female neurasthenics. ³The poet took Mitchell’s advice seriously and embarked on a trip to Colorado, after which he professed himself cured.

While Osler’s optimistic persona must have pleased many patients, it irritated Whitman. He judged his doctor’s cheerfulness to be insincere, or at least questionable. The elderly poet was an eccentric who fiercely valued his independence. While at times he showed a sweet and gentle side, he could also be touchy, irascible, and assertive. As the poet grew progressively frailer during 1888 and 1889, Traubel recorded a series of house calls during which Osler assured him that he would soon recover. “Do not take a gloomy view of Whitman’s case,” Osler told Traubel, “he will come around.” ²^{, July 3, 1888} In this short poem, I try to resurrect the poet’s attitude toward his famous doctor:

Walt Whitman Reflects on His Doctor’s Bedside Manner

As an old rat that must be allowed to die
in his own way, I start with a prejudice
against doctors. Never mind worrying

about your sickness, he scolds me,
I’m seeing to all that. The man tinkers
with platitudes and conceals his thoughts.

In his gospel of encouragement
I’m supposed to be agreeable and dumb
while he puts the best construction

on what’s happening. What does he know
about Whitman, the old rat? A shoemaker
tells his customer the shoe fits just right
but the shoe pinches the fellow wearing it.

Whitman was a master of self-promotion. He appeared to encourage members of his inner circle who viewed him as a prophet, as well as a poet. Dr. Maurice Bucke even wrote a book claiming that his friend was one of the few humans who had achieved “cosmic consciousness.” The others included Jesus, Mohamed, and the Buddha. Did Osler fail to understand that his one- size- fits- all approach to physician-patient communication might not be appropriate for a patient with Whitman’s complex and eccentric personality?

Although dissatisfied with Osler’s bedside manner, the poet respected his doctor’s clinical abilities. Several months after the medical crisis in 1888, Whitman wrote, “As for Osler: he is a great man—one of the rare men. I should be much surprised if he didn’t soar way, way up—get very famous at his trade—someday. He has the air of something about him—of achievement.”²^{, December 26, 1888}Indeed, by that time, Osler had already accepted the position of Professor of Medicine at the new Johns Hopkins medical school in Baltimore.

Osler was a sensitive, cultivated man, but also a rationalist, who initially looked askance both at Whitman’s exuberant poetry and the cult that had grown up around its author. Although he admired the man, he had no wish to become a disciple. He loved poetry and enjoyed quoting passages from Shakespeare and the Romantic and Victorian poets. Regarding his first impressions of Leaves of Grass, Osler later wrote, “Whether the meat was too strong, or whether it was the style of cooking—‘twas not for my pampered palate.” ^1,^{p. 22}He found his new patient’s long, unruly poems and earthy subject matter self-indulgent and lacking in discipline. The boisterous persona reflected in Whitman’s poems jarred Osler’s methodical mind. In the following poem, I imagine the clinician’s response to his early encounters with the Good Grey Poet:

Dr. William Osler Remembers His Call on Walt Whitman

I took the ferry that day and found him
in the front room of a small house
on Mickle Street, buried to his chest
in papers, magazines, and musty
brown bundles. Push yourself a path,
he said. I reckon you’re a friend of Bucke’s.

His famous head had aged majestically—
unkempt white beard; smooth, clear cheeks;
a fissured, geographic forehead.
His voice was pitched a shade too high,
but strong like the rest of him. Of symptoms
he said but little–remarkable

for a man of 65. For a moment
I felt that sweet aromatic presence
his disciples spoke of–for me, though,
the edge of chaos. I sometimes wish
the man had made a difference in my life,
opened me up, but how could I forego

my restraint? Or professional kindness?
For a man like me, a man of substance,
what could be worse than falling in love
with Whitman? I listened to the music
of his tongue, but could never cross the line
that reads, Who enters here, abandons discipline.

Yet, in his later years, Osler grew to respect his one-time patient’s poetry, as well as his charismatic personality. In fact, at the time of his death from pneumonia in 1919, he was in the process of writing an appreciative reminiscence of his encounters with Whitman.

The uneasy, but respectful, relationship between these giants in their respective fields provides interesting material for reflection. If the poet was so dissatisfied with Osler, why didn’t he go back to Weir Mitchell or his son, who were more easy-going and communicative? Mitchell’s reputation as a clinician easily equaled Osler’s, and he was a poet as well. Could it be that Whitman benefited in some way from Osler’s staunch optimism, or had developed deep trust in Osler’s judgment, despite the constant complaints he issued to Traubel and others? Alternatively, why didn’t Osler modify his paternalistic approach, since it seemed clear that Whitman preferred to play a more active role in the relationship? And those time-consuming house calls that required taking a ferry across the river! Why not recommend a more pliable colleague?

References

Philip Leon, Walt Whitman & Sir William Osler, ECW Press, Toronto, 1995.

Horace Traubel, With Walt Whitman in Camden, vol. 2, at http://whitmanarchive.org/criticism/disciples/traubel (accessed December 30, 2024)

Feinberg CE. Walt Whitman and his doctors. Arch Intern Med 1964; 114: 834-842.

Photo of Sir William Osler and Walt Whitman from WikiCommons.

Knife by Salman Rushdie

Howard Trachtman — Fri, 27 Sep 2024 20:48:07 +0000

Salman Rushdie’s life story is a well-known tale. It has become an allegory of sorts in these tense times of global religious fanaticism. To briefly summarize, Rushdie achieved sudden world-wide fame in his thirties with the publication of Midnight’s Children, a winner of the Booker award in 1981. It is now considered the best novel of all the winners over the 40 years that the prize has been awarded (the Best of the Booker web page). He then authored a fourth book, Satanic Verses, in 1988 that triggered the ire of Muslims around the world who accused Rushdie of defaming the prophet Mohammed and denigrating their faith. A fatwa was proclaimed on Rushdie by Ayatollah Khomeini and the imams in Iran forcing him to live in semi-hiding with 24-hour police protection for the next 20 years in London. In 2006, after nearly 20 years of quiet, he moved to New York and decided to gradually come out of seclusion. Life was good to him and, in 2021, he was married for the fifth time, to the woman of his dreams, the poet Rachel Eliza Griffiths.

For nearly two decades after the fatwa was issued, his literary career flourished, and he became a visible spokesperson for freedom of artistic expression. As president of PEN, Rushdie promoted initiatives to protect and promote the careers of writers living in fear under repressive political regimes. In August 2022, he was invited to speak on this topic at the Chatauqua Institution, an adult education and social movement. On a sunny summer morning, as he sat on the stage of the amphitheater to begin a public conversation with his interlocutor at Chatauqua, he noticed a man dressed in black suddenly rise up from the middle of the audience and charge the platform. There was no security at Chatauqua that day or any other day because the violent world had never intruded into the bucolic space of the institution during its entire 148 year history. Rushdie found himself rooted to the spot, frozen and unprepared to defend himself as the attacker stabbed him seventeen times – in his eye, his face, his neck, his chest, his abdomen, his hand. Heroic people charged the stage and subdued the assailant. Miraculously, Rushdie survived and he was helicoptered to the nearest trauma center for emergency treatment. Knife is a meditation on the event, the ordeal of rehabilitation that Rushdie had to endure, and his reaction now that he is healed, and his life is restored.

Knife is a visceral book that is grounded in the harsh reality of crazed, religious zealots and painful, tedious rehabilitation. It is different from the magical prose that characterizes much of Rushdie’s writing. The events are described in excruciating detail. One can feel the hurt and sense the worry etched into the pages. It is testament to the many doctors and nurses and therapists who took part in his bodily reconstruction and long convalescence. Most of all it is an inspiring testament to his wife who had the fortitude to be at his bedside throughout the entire ordeal . Rushdie gives her most of the credit for his stamina, the tenacity and resilience that he displayed during the long months after the attack. He substitutes an imaginary dialogue with his attacker in lieu of a face-to-face encounter in prison to express his contempt for his religious intolerance. Rushdie and his wife summon the courage to revisit the Chautauqua stage one year after the attack and achieve some degree of closure on the event.

Differences in fame and access to expertise do not ultimately carry the day. Instead, it is how we as individuals, regardless of our wealth or social status, are able to tap our inner strength and utilize the help and support of our loved ones.

There is much humanity and wisdom in these pages, lessons on how to confront and overcome adversity. One might question what we, mere mortals, can learn from a singular person like Rushdie who was blessed with such an abundance of human and professional resources to draw on as he recuperated from his injuries. However, differences in fame and access to expertise do not ultimately carry the day. Instead, it is how we as individuals, regardless of our wealth or social status, are able to tap our inner strength and utilize the help and support of our loved ones. The task for us all is to draw on our cognitive and psychological reserves and convert life-threatening tragedies into surmountable setbacks. If, like Rushdie, we succeed, then we will have reached a more mature and meaningful embrace of life in all its beauty and complexity. Rushdie’s story played out in the international limelight. The narrative also unfolds every day on countless hospital floors and rehabilitation units the world over as people strive to overcome injury and illness in their own private world. Rushdie’s template is universal.

But for readers of the Medhum website, I suggest that there is an unspoken but instructive message lurking in Rushdie’s story, specifically for health care providers, doctors and nurses both. There were unexpected turns of events during Rushdie’s recovery. It was not an uninterrupted march from near death to healing. He experienced disabling complications from medications that were prescribed for rational clinical reasons, iatrogenic problems. In one case, severe urinary retention requiring repeated painful bladder catheterization, it was only through the astute observation of one of the clinicians that the causative medication was stopped and the problem spontaneously resolved. In another, he experienced symptomatic hypotension, a disabling side effect of one of the drugs prescribed for him. There was a cancer scare when an imaging study performed to assess his urological problems. suggested he might have a lesion in his prostate. He experienced excruciating pain when his eyelids needed to be sutured together to protect his injured eye. In each case, Rushdie was reassured that things were proceedings according to plan and that things should improve with time. Follow up tests were done to monitor the prostate anomaly and confirm improvement in his symptoms but the discomfort and unease lingered in his body and his mind. The anxiety that the problems might not resolve was ever present in Rushdie’s consciousness.

Doctors know that recovery from injury or illness is a time consuming process that rarely occurs overnight. They are right to encourage their patients to take the long view of their health problems, to reassure them the treatment is usually a continuing proposition. But even for a highly intelligent patient like Rushdie, the doctor’s confidence in how things were going could never completely allay the fear that his broken body would not heal, and his health would not be restored to what it had been pre-knife attack. Daniel Kahneman and Amos Tversky won the Nobel Prize in Economics in 2002 for groundbreaking studies that explored how people assess loss and gain and make financial decisions. Kahneman expanded on their studies in behavioral economics and proposed that rational thought utilizes two operational modes. System 1 is rapid and instinctive in contrast to system 2 which is slower, more deliberative, and more reasonable. Channeling this work by Kahneman, there may be two systems operating during recovery from bodily injury. Doctors may be employing an analog System 2 method of thought as the disease is steadily halted, reversed, and repaired. Patients, however, live through illness in a binary System 1 approach of thought: sick or back to normal. We physicians would do well to remember that the only words our patients really want to hear from us when they come to us for care are, “You are now fine. We can stop the medications and stop the follow up. You are back to normal.”

Knife
Salman Rushdie
Knopf 2024, 209 pages

Interview with Poet B. Fulton Jennes

Cortney Davis — Thu, 02 May 2024 22:22:05 +0000

When I first read Blinded Birds, an award-winning collection of poetry by B. Fulton Jennes, I entered a world I assumed I knew. After a long career in nursing, I thought I was familiar with the wages of depression and addiction. But the poems in Blinded Birds took me deep into new territory, into multigenerational suffering and almost miraculous recovery. I was eager to talk with Jennes to find out more about these brave poems and her willingness to expose her family’s long hidden afflictions.

Cortney Davis: The poems in Blinded Birds are startling and sometimes difficult to read. Can you talk about the process of writing such personal poems–how you considered the idea of “truth” in poetry as you were writing?

B. Fulton Jennes: The poems in Blinded Birds are 100% autobiographical. One of the book’s reviewers called them “brutally honest,” and many people have told me they needed to stop reading to compose themselves before continuing (I guess that’s a compliment!). The intent was not to shock but, rather, to heal. For me, the only path to that healing was complete, unfiltered honesty. As we say in the program, you’re only as sick as your secrets, and I’d been holding in those poisonous secrets for far too long. Poet Anne Carson might insist that art is not therapy, but it was for me in writing these poems.

CD: Blinded Birds is your first poetry collection, but you’ve been writing award winning poems for some time. When did you begin your journey as a poet?

BFJ: When I was a child my grandmother used to read to me from my father’s copy of A Child’s Garden of Verse; I loved the rhymes and the musicality of the poems. Also, my mom wanted to be a writer when she was in high school. She used to write poems with me in the morning before I went to school. Of course, I took all the credit for them with my teacher!

CD: And now you’re writing poems that are like explosions on the page, visceral and stripped-bare. How did you come to write these particular poems? Was there a triggering event?

BFJ: It was after we discovered my daughter Mallory’s heroin addiction. Mal was home from college and preparing to begin overseas graduate studies when we found her overdosed and, essentially, dead on her bedroom floor. Fortunately, I was able to resuscitate her until the EMTs arrived, so she lived and entered a residential treatment program. But processing all that happened in the months that followed–including Mallory’s subsequent relapse and years of active addiction–threw both my husband and me into a state of perpetual PTSD. It also evoked memories of my own addiction to alcohol, including during Mal’s infancy (I relapsed when her pediatrician advised me to drink beer because my milk production insufficient and she was losing weight. I’m an addict–who was I to argue?). Additionally, she and I have both been treated for depression since childhood (I was on Valium when I was 12, for God’s sake–and Mallory’s depression manifested much earlier), and my mother suffered from horrible depression, most likely untreated bipolar disorder, throughout my childhood. So all of those factors congealed during this period–the memories, the fears, the regrets, the anger, the sorrow. The only way I could manage was to write my way through.

CD: Writing the poems must have been an extraordinary experience. Your poems about saving Mallory’s life (“Eating Dinner, After You Died,” “The Waitings”) begin in despair and end in hope. You might have kept these poems to yourself but chose to offer them publically in a collection. How did the publication of this book affect you emotionally and how have the poems affected your family?

BFJ: Let’s start with my family, first and foremost my daughter since she is a central character in the collection’s story arc. By the time I was ready to submit Blinded Birds to publishers, Mallory was in relatively long-term recovery–in fact, she had gone to graduate school to become a certified addictions counselor. I would never have published the poems without her permission, and she readily gave it, realizing not only the personal importance of telling our story but also the potential of connecting with others and offering them hope as a result since the final poems in the collection celebrate our joint recovery. Sadly, my mother–the third central character in the book–never achieved relief from her depression before she died. She was of a generation that clung to the belief that depression is a character flaw, not a treatable medical condition–much as addiction is still shrouded in stigma today. My husband was behind the book 100%. The rest of the family, including many who never realized our ongoing struggles with mental illness, were initially shocked but ultimately supportive. We got a lot of, “I’m so sorry–I never knew,” which just shows how well we hid the truth for so long.

I can feel the healing they’ve received from knowing they’re not alone. It’s therapeutic for all of us–the giver and the receivers of hope.

How did the book’s publication affect me emotionally? I think both Mallory and I feel really empowered by having the truth out in the open for others to learn from and, perhaps, glean hope from. Every time I finish a reading, people from the audience approach me to share their stories, especially ones about their own children who suffered, or suffer, from addiction. I can feel the healing they’ve received from knowing they’re not alone. It’s therapeutic for all of us–the giver and the receivers of hope.

CD: Your poems seem to be “spot on” in examining the cultural and societal issues so many families struggle with today. It has been said that the personal is universal, and your very personal poems speak directly to these issues. Was that something you considered when writing, that your work might help others understand the genesis and effects of addiction?

BFJ: It’s only in studying how others react to the poems that I’ve developed a keener awareness of society’s misevaluation of addiction and addicts. However, while drafting the poems, I definitely took a “genetics as culprit” approach. The three of us recently had genetic testing done, which revealed that both Mallory and I have the A1 allele. In study after study, that mutation on the brain’s dopamine receptors has been very closely linked to early-onset depression, severe alcoholism, ADHD, intractable PTSD, and a heightened risk for addiction to opioids. There are two poems at the beginning of the book that highlight the fury I feel at being a victim of genetics: “Blinded Birds” and “To an Allele.” And I wish I could have shared those findings with my mother who no doubt blamed herself rather than her genetic inheritance for her lifelong depression. (Her father was severely alcoholic and despondent; two of her siblings committed suicide.)

CD: When you understood the genetic component of depression and addiction did you feel relieved somehow of guilt or blame? I very much admire your poem “Triple Helix” that helps you “pry apart the DNA / that twists our fates together . . . .”

BFJ: Vindicated, perhaps, but not guiltless. There’s another poem in the book titled “Every Bad Thing That Ever Happened to Me Happened When I Was Drunk,” and that’s pretty much the truth of it. And not just the bad things that happened to me, but the bad things I imposed upon others, most notably my daughter. I relapsed twice during her childhood: once when she was an infant (the poem “Alky Mommy” speaks to that) and again when she was a teen–the two most impressionable periods in a child’s development. During those times, I was unavailable to Mallory on many levels. That’s why there’s so much regret and sorrow mixed with anger in discovering the genetic connection to addiction–my genes might have opened the door for me, but I’m the one who wrecked the room.

CD: Yet you did not leave the room in shambles. The last several poems in Blinded Birds speak to healing and resolution. In the book’s last poem, “Hovenweep,” you write “And then you, a damaged daughter, saved me. / And then I, a mother damned, saved you.” Do you have a favorite poem among those that bring the book to a close with hope?

BFJ: Yes! My favorite is “Return,” the second-to-last poem in the collection. I still connect to it, feel its power, whenever I read it. In it, I metaphorically compare recovery to a tree reawakening after a long winter, a long night. Isn’t that exactly what it feels like, the first time you wake up and don’t ache for a drink or a fix? You feel alive again. It’s remarkable. Like being reborn.

CD: You often give well attended readings. Is it difficult for you to share such emotional and revealing poems?

BFJ: Not at all. As I’ve mentioned, I can feel the healing that’s happening in the room–both for me and for those in attendance. Sure, there are some who can’t scurry away quickly enough after the reading (!), but I tell myself that they’re the ones who most needed to hear the poems.

CD: Yes, sometimes we experience something–a poem that cuts too close perhaps–and it’s often only later that we realize how we’ve been touched, been changed. Has writing Blinded Birds changed you or your family in any way?

BFJ: Personally, I’ve gained confidence on many levels since the book’s publication–as a poet, as a public speaker, as a truth-teller and giver of hope. I’m unafraid–unlike all those years I felt hidden and hurt by the truth. I think everyone in the family feels pretty much the same.

CD: Once in a lecture years ago at NYU the poet Yehuda Amichai said that in war, poems can’t save us. Do you think poetry can save us? Can it bring about changes in our society?

BFJ: It certainly has saved me on more than one occasion. So on a personal level, absolutely: poetry saves. But I see the powerful poems being written about the atrocities occurring in so many places today, and while those poems have impacted my sense of urgency and compassion, I don’t see that power playing out on a political level. I think the effect of art–whether poetry, song, or visual art–is limited to moving a pre-disposed audience. Sadly, they “preach to the choir”–albeit powerful and affective preaching.

CD: And now that Blinded Birds has found wide readership, tell me about your latest book. You’ve written again about your family, but this time about a special and specific person.

BFJ: Yes–FLOWN (Porkbelly Press, 2024) is an elegy-in-verse for my late sister, who died of metastatic breast cancer in July of 2022. It’s a chapbook of very short poems, written during the final months of Harriet’s illness and the days and weeks just after her passing. It’s raw, very raw. I still relive the anguish of those days when I read the poems.

CD: how was writing this book different from—or similar to—writing Blinded Birds?

BFJ: In terms of differences, the biggest one was that FLOWN was written while the events were transpiring, rather than in retrospect. It was a period of deep recollection and reflection, sussing–intuiting really–the metaphoric connections between Harriet’s illness (which we knew from the first diagnosis was terminal) and events from our childhood. There were four years between us, so I learned a great deal from her when we were young, just as she taught me so much about life and about the process of dying with her illness and eventual passing.

Both books are rich in symbolism, which I guess was the greatest similarity in writing them. The title and title poem of Blinded Birds reference the old Flemish tradition of vinkensport, in which chaffinches being trained to compete in contests that require them to repeat their distinctive song the most times per hour were once blinded with hot needles to minimize distraction during competition. Cruel, right? I used that analogy to illustrate the cruelty of genetics in predetermining our propensity for addiction–and, yes, of any god who would create genetic mutations in the first place and use them for his “sport.” That metaphor echoes through the poems, just as the symbols of holes (including graves) and birds make repeated appearances throughout FLOWN. 

CD: And one question about your poetic process. Do you have any special inspirations or habits that help you create? Sharon Olds once said that she finds inspiration in walking across water. Some poets have elaborate pre-writing rituals, or must have silence, or can only write at a table at Starbucks.

BFJ: For me, it’s hard to find a place quiet enough to write, to achieve that feeling of being completely removed from the world. So I usually draft my poems wearing headphones and listening to either Philip Glass or to theta wave-inducing music online. Both are very hypnotic for me and allow me to reach my Zen place.

CD: As one of your fans, I’m grateful for the words and images that arise from your Zen place! Finally, is there a message or a realization that you hope readers will take away after reading Blinded Birds?

BFJ: First, addiction and depression are genetic “gifts” that no one asks to receive. They are treatable conditions, deserving of society’s and the medical community’s non-judgmental compassion and support, not its dismissal and neglect. Second, there is always, always hope. The path to recovery is fraught with physical and mental anguish, blame-placing, and failure, but keep going. Keep going. Keep going. And help others on their path, too.

B. Fulton Jennes is Poet Laureate Emerita of Ridgefield, CT, where she also served for many years as poet-in-residence at The Aldrich Contemporary Art Museum. Her poems have appeared in CALYX, Comstock Review, Extreme Sonnets II, Rust and Moth, SWWIM, Tupelo Quarterly, and many other journals and anthologies. Jennes’ poem “Glyphs of a Gentle Going” was awarded the 2022 Lascaux Prize; another poem, “Father to Son,” won the 2023 New Millennium Award. In 2021, her poem “From the Room of an Unknown Girl” was awarded the Leslie McGrath Prize. Jennes’ first collection of poems, Blinded Birds (Finishing Line Press), received the 2022 International Book Award for a poetry chapbook. Another chapbook, FLOWN—an elegy for her late sister—will be published by Porkbelly Press in 2024. She lives in Ridgefield with husband Chuck.