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

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

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

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

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

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

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

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

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

Photo of Alphonse Daudet from Wikicommons.

At age nine, first misdiagnosed and finally identified as having facial bone cancer (Ewing’s sarcoma), Lucy underwent several surgeries and more than two years of intensive chemotherapy and radiation treatments. Pain and nausea, anxiety and fear of more pain and nausea were only part of the ordeal. The young Lucy became aware of what it is to be severely, chronically ill. Her sisters behaved differently toward her: they were polite. “Suddenly I understood the term visiting. I was in one place, they were in another, and they were only pausing.” Even her father felt uncomfortable at her hospital bedside, and Lucy was relieved that he came infrequently.

But being at home was worse: in the hospital the other patients and the staff expected little from her and she felt no guilt or shame; amidst her family, she blamed herself for the tension, arguments over money, and her mother’s depression, even though these elements had existed prior to her illness. Her hair fell out and she became dimly aware that people were staring at her face. Nevertheless, “I . . . was naturally adept at protecting myself from the hurt of their insults and felt a vague superiority . . . . “

Well enough to return to school, Lucy’s disfigured face drew taunts from classmates; she understood finally that she was perceived as ugly and that she would not be loved. Only on Halloween, when she could mask her face, did she feel free and joyful, unconcerned about her appearance, “normal.” Her moods now alternated between despair, determination, and escapism. She became convinced that only facial reconstruction and a restored appearance would make life bearable.

During years of reconstructive surgery Lucy evolved complex rationalizations to give meaning to her suffering. Two anchors had stabilized her existence throughout the misery: a passionate adolescent love of horses, and an adult love of poetry. Eventually outward appearance and inner life became harmonious. “The journey back to my face was a long one.”

Unfortunately, Lucy’s story does not end here. At age 39 she committed suicide. Soon after, her close friend, writer Ann Patchett, wrote a book about their friendship, Truth & Beauty: A Friendship, published in 2003 (HarperPerennial).

Lucy Grealy Interview in 1994 (20 Min.)

Autobiography of a Face
Lucy Grealy
Houghton Mifflin 1994 Boston: 256 pages

1995 Whiting Award Winner in Nonfiction , Poetry: https://www.whiting.org/awards/winners/lucy-grealy
Web image generated from the book cover by Medhum.

At age 18, Frida Kahlo suffered a catastrophic accident that had lifelong consequences. The school bus in which she was a passenger collided with a trolley. Her spinal column was broken in three places, as were her collarbone, two ribs, her right leg and foot. The treatment was to lie on her back for one month, enclosed in a plaster cast. In addition, Kahlo had polio as a child, and one leg was shorter and thinner than the other.

This stunning portrait demands the viewer’s attention. A woman, Frida Kahlo, looms in the foreground, central to the painting, facing the viewer fully frontal, a few tears spilling down her face. She is nude, except for a sheet that is wrapped around her foreshortened lower body, and the widely spaced straps of an upper-body corset. On the one hand, the figure is passive, gazing at us almost without expression, completely still, acceptant of the scattered nails and rigid column that penetrate her body. On the other hand, the beauty of her perfectly formed breasts and well-formed upper body, the eyes that engage the viewer, subtly convey the energy of the figure’s spirit and will. At this point in Kahlo’s life, the painful physical problems that had plagued her on and off for years were becoming unrelenting. Doctors prescribed a variety of orthopedic corsets to support her degenerating spine. The portrait seems to personify pain and simultaneously some level of tolerance for pain.

Many who view the painting are reminded of images of Christ on the cross. Kahlo was certainly long-suffering and represented the physical and emotional aspects of her condition in many of her works (for example, “Tree of Hope” and “Henry Ford Hospital“), but the energy and originality of her personality and artistic vision shine through. For interesting commentary on “The Broken Column,” see Hayden Herrera. Frida Kahlo: The Paintings (New York: Harper Perennial) 2002, pp. 180-183. Also useful is Gannit Ankori’s commentary in her book, Imaging Her Selves: Frida Kahlo’s Poetics of Identity and Fragmentation (Westport, Connecticut and London: Greenwood Press, 2002, pp. 114-119). Ankori points out that the vertical fissure of Kahlo’s body and the fissures in the earth surrounding her evoke violation — consistent with Kahlo’s statement that a metal rod had entered her hip and penetrated her vagina.

Web image from Wiki Commons

Among the scores of essays Montaigne wrote, while occasionally serving in various government roles, are accounts and commentaries concerning many of his infirmities. Kidney stone attacks in particular plagued Montaigne, and so they became subject matter for several essays. His focus on “the stone,” as he called this condition, generally concerned the physical and mental suffering acute attacks caused him, his work at reconciling a life with intermittent attacks, and from these two features, the profit his attacks afforded him. (N.B. I have drawn Montaigne’s words from the Everyman’s Library collection of Montaigne’s essays.)

Attack of The Stone

Pain from acute kidney stone attacks always ranks amongst the worst humans suffer from diseases, injuries, or various conditions. Montaigne’s vivid and horrifying descriptions of his kidney stone attacks lend credibility to these rankings: “I am at grips with the worst of all maladies, the most sudden, the most painful, the most mortal, and the most irremediable.” (p. 698)

To others looking on during one of his attacks, Montaigne says: “They see you sweat in agony, turn pale, turn red, tremble, vomit your very blood, suffer strange contractions and convulsions, sometimes shed great tears from your eyes, discharge thick, black, and frightful urine…” (p. 1019) No observer could doubt the intensity of pain kidney stone attacks produce after reading Montaigne’s accounts; no current sufferer would contradict them. 

A Life Accommodated

The pain and agony kidney stones inflict are never forgotten. And, the fear of knowing they will strike again is ever present, with good reason; they often return time after time. Indeed, this threat is a form of suffering of its own. Montaigne was cognizant of this reality, and writes about how he learned to live with the inevitability of a next attack. 

In the eighteen months or thereabouts that I have been in this unpleasant state, I have already learned to adapt myself to it. I am already growing reconciled to this colicky life; I find in it food for consolation and hope. So bewitched are men by their wretched existence, that there is no condition so harsh that they will not accept it to keep alive. (p. 697).

His primary approach was adopting a mentality allowing him to maintain as much function as possible while under frequent sieges of the stone: “I have kept my mind, up to now, in such a state that, provided I can hold fast, I find myself in a considerably better condition of life than a thousand others, who have no fever illness but what they give themselves by the fault of their reasoning.” (p. 701) Montaigne advises these thousand others they would do well to adjust their reasoning because the problem “occupies in us only that much room as we give it.” (p. 47) As for how much room to give the stone, he says, “we have no cause for complaint about illnesses that divide the time fairly with health.” (p. 1020)

With his reconciliation of a life with the stone, Montaigne carries on as close to a normal life as possible and not being obsessed with his condition: “Do not expect me to go and amuse myself testing my pulse and my urine so as to take some bothersome precaution; I shall be in plenty of time when I feel the pain, without prolonging it by the pain of fear.” (p. 1023) 

Profitable Kidney Stones

“I have in [my] time become acquainted with the kidney stone through the liberality of the years. Familiarity and long acquaintance with them do not readily pass without some such fruit.” (p. 697) The fruit is the profits he gains with kidney stones. The profits derived mainly from lessening his fear of death, better appreciating the health he had, and getting on with his life more easily. As such he has profited from receiving benefits exceeding the costs he incurred through suffering. 

“I’m not dead yet.” Montaigne wrote that when the stone visited him, he felt he was “so far forward into death that it would have been madness to hope, or even to wish, to avoid it, in view of the cruel attacks that this condition brings.” (p. 771) He had come face to face with death on those occasions only to survive. What he gained from these encounters he eventually appreciated as a form of profit. 

I have at least this profit from the stone, that it will complete what I have still not been able to accomplish in myself and reconcile and familiarize me completely with death: for the more my illness oppresses and bothers me, the less will death be something for me to fear. (p. 698) 

“What a feeling.” The perception of good health is created mostly either by various metrics like physical fitness standards (e.g., weight, strength, endurance), medical diagnoses, and other empiric findings, or by contrasts to states of bad health. Montaigne claimed great profit because his kidney stones reminded him how good his health is generally when he’s not in the midst of an attack. 

But is there anything so sweet as that sudden change, when from extreme pain, by the voiding of my stone, I come to recover as if by lightning the beautiful light of health, so free and so full, as happens in our sudden and sharpest attacks of colic? Is there anything in this pain we suffer that can be said to counterbalance the pleasure of such sudden improvement? How much more beautiful health seems to me after the illness, when they are so near and contiguous that I can recognize them in each other’s presence in their proudest array, when they vie with each other, as if to oppose each other squarely! (p. 1021)

Montaigne also perceived profit from the finite nature of kidney stone attacks. He points to the abrupt resolution of an attack followed by a quick return to good health in contrast to other diseases causing their victims continuous suffering: “My sickness has this privilege, that it carries itself clean off, whereas the other always leave some imprint and change for the worse that makes the body susceptible to a new disease.” (p. 1022)

“Brush off the clouds and cheer up.” To Montaigne, kidney stone attacks are gruesome and can make the sufferer wish to die. But, by their nature, and as a form of profit, they can make life better between attacks than it would be otherwise. Montaigne sees this profit in the certainty that any attack will end and lives can go on as planned, because the stone is “a disease in which we have little to guess about. We are freed from the worry into which other diseases cast us by the uncertainty of their causes and conditions and progress—an infinitely painful worry.” (p. 1023) This means for Montaigne, that the stone “almost plays its game by itself and lets me play mine. (p. 1022)

The idea that there can be profit or any form of benefit from having kidney stones is likely preposterous to modern day sufferers, especially when effective analgesics and surgical techniques for acute attacks and methods for preventing them are available. Many people, however, still struggle with chronic kidney stones making Montaigne’s observations and advice relevant yet. Drawing from a cultural analog, he might tell them to look for the profit kidney stones generate, and when found, they will see that gray skies are going to clear up, so put on a happy face. Alas, his admonition would likely be met with stony silence. 

Kidney stone image from the gallery at KidneyStoners.
Title image credit: Three Kidney Stones Highlighted in Red. Sanderlewis, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Commonly argued among readers is whether fiction or nonfiction brings the most value to understanding any particular issue. These arguments sometimes end with one interlocutor saying, “I only read nonfiction,” and the other saying, “I only read fiction.” Choosing either one alone, however, can deprive readers of valuable knowledge and perspectives that only both together can provide. Such is the case when reading Laura Spinny’s history, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, and Kathryn Anne Porter’s “short novel”—as she insisted it be called—Pale Horse, Pale Rider. Spinny researches the effects the pandemic had on exposed populations and Porter conjures the effects it had on infected individuals.

The titles for both Spiney’s book and Porter’s story draw from the the Four Horsemen of the Apocalypse in the Book of Revelation (6:8) in the New Testament, and one of the horsemen in particular.

And I looked, and behold, a pale horse! And its rider’s name was Death, and Hades followed him. And they were given authority over a fourth of the earth, to kill with sword and with famine and with pestilence and by wild beasts of the earth.

Both books speak of death, not as the natural course of human life, but resulting from an apocalypse of a biblical scale, of a vengeful god, and of a plague in form. Spinney applies the apocalypse metaphor to peoples and Porter to persons.  

Spinny’s account focuses on how the 1918 flu pandemic altered history.

The flu resculpted human populations more radically than anything since the Black Death. It influenced the course of the First World War and, arguably, contributed to the Second. It pushed India closer to independence, South Africa to Apartheid, and Switzerland to the brink of civil war. (p. 8)

She also describes how national public health and global health organizations reorganized and generated momentum towards today’s more sophisticated agencies. She suggests further that the flu pandemic affected literature and art as well, and speculates about why it’s not remembered in any way like the two world wars of the same century. The bulk of the book, though, describes what happened to populations, and how this pandemic could be considered an apocalypse.

The number of dead could have been as high as 100 million—a number so big and so round that it seems to glide past any notion of human suffering without even snagging on it. It’s not possible to imagine the mystery contained within that train of zeroes. All we can do is compare it to other trains of zeroes—notably, the death tolls of the First and Second World Wars—and by reducing the problem to one of maths, conclude that it might have been the greatest demographic disaster of the twentieth century, possibly of any century.(p. 171)

This is where Porter’s literary contribution to capturing “any notion of human suffering” comes in—the personal apocalypse. Based to a degree on her own experience surviving a case of the 1918 flu, her short novel follows Miranda, a reporter for a local newspaper in Denver, Colorado, during a time when she is early in a courtship with Adam, a soldier on leave from camp but who is soon to be shipped overseas to the battlegrounds of WWI. Together they start to see the flu engulf the area.

“I wonder,” said Miranda. “How did you manage to get an extension of leave?”
“They just gave it,” said Adam, for no reason. The men are dying like flies out   there, anyway. This funny new disease. Simply knocks you into a cocked hat.”
“It seems to be a plague,” said Miranda, “something out of the Middle Ages. Did you ever see so many funerals, ever?” (p. 281)

Then, the flu engulfs Miranda, and Porter helps us imagine what a personal apocalypse could be like when an individual succumbs to it. She imagines the Pale Rider pulling her away from her physical moorings on Earth.

I must give up, I can’t hold out any longer. There was only that pain, only that room, and only Adam. There were no longer any multiple planes of living, no tough filaments of memory and hope pulling taut backwards and forwards holding her upright between them. There was only this one moment and it was a dream of time, and Adam’s face, very near hers, eyes still and intent, was a shadow, and there was to be nothing more… (p. 304)

Eventually the Pale Rider tries to pull her away from even any vestige of her corporeal being itself, and were it for a mere particle of life force would have done just that.

Silenced she sank easily through deeps under deeps of darkness until she lay like a stone at the farthest bottom of life, knowing herself to be blind, deaf, speechless, no longer aware of the members of her own body, entirely withdrawn from all human concerns, yet alive with a peculiar lucidity and coherence; all notions of the mind, the reasonable inquiries of doubt, all ties of blood and the desires of the heart, dissolved and fell away from her, and there remained of her only a minute fiercely burning particle of being that knew itself alone, that relied upon nothing beyond itself for its strength; not susceptible to any appeal or inducement, being itself composed entirely of one single motive, the stubborn will to live. This fiery motionless particle set itself unaided to resist destruction, to survive and to be in its own madness of being, motiveless and planes beyond the one essential end. Trust me, the hard unwinking angry point of light said. Trust me. I stay. (p. 311)

Many published histories of the 1918 flu pandemic concentrate on the devastation visited upon nations and populations. Most stop at the individual, because historians rely on tangible and verifiable facts, but literary fiction writers can turn personal narratives into stories that render pictures of what individuals could experience with particular illnesses. These two books referencing Pale Horse, Pale Rider in their titles—one a nonfiction history and the other a literary fiction—work well in combination to capture the experiences and consequences of this flu on both populations and individuals. Further, these two books show why fiction and nonfiction accounts of particular subjects should not be considered a choice, but rather as opportunities to get fuller accounts of diseases on populations and individuals.

Revelation 6:8, English Standard Version (ESV). © 2001 by Crossway; text edition: 2025.
‘Pale Horse, Pale Rider’ In The Collected Stories of Katherine Anne Porter, Harvest, 1979.
Spinney L. Pale Rider: The Spanish Flu of 1918 and How it Changed the World. New York; Public Affairs, 2017)
Web image generated by Gemini AI

The nature of phantom limb pain has bedeviled amputees and bewildered physicians and surgeons for centuries; up to 87% of amputees experience it during their lifetime. Consistently effective treatments remain elusive. Biomedical texts on the subject are at once complex and speculative. Olga Tokarczuk, in her 2018 novel, Flights, imagines what phantom limb pain could be like for someone, and the desperate search for relief it can produce. 

Flights centers mostly on the narrator’s travels among different places and across different times. It comprises mostly packets of individual story vignettes and fragments; some short, some long; some fictional; some real, some both. And though many different stories are told with many different characters about many different subjects, something about travel connects them all.  

Certain preoccupations manifest themselves in various parts of the book. One in particular concerns the technical aspects of preserving human body parts, which comes into play in a story fragment involving phantom limb pain. The main character is Philip Verheyen, who is a real historical figure known as a renowned Flemish surgeon and anatomist of the late seventeenth and early eighteenth centuries, and as the author of Corporis humani anatomiae (1710).  

As Tokarczuk tells the story, Verheyen was twenty-eight-years old in 1676 during his second year of university in Leiden when he scraped his left calf on an exposed nail of the stairway leading to his rented lodgings. His pants were torn and his skin broken. Though the injury seemed minor at first, it evolved into a raging infection that later required below-the-knee amputation.  

With the care of his landlady, Verheyen recovered after which he was seen “tapping his peg over the uneven paving stones of Leiden,” to attend lectures on the subject of anatomy at the university medical center.” (p. 195) In a matter of a few weeks after the amputation, however, the pain started. 

The pains came at night as his body was relaxing and slipping across the uncertain boundary between waking and sleep…He would have the impression that his left leg was numb, and that he absolutely had to get it into the right position—he felt his toes tingling, an unpleasant sensation. He fidgeted, half conscious. He wanted to move his toes, but the unperformability of that movement awoke him completely. He would sit on the bed, tear the blanket off himself, and look at the aching place—it was some thirty centimeters below the knee, there over the rumbled sheet. He would close his eyes and try to scratch it, but he touched nothing, his fingers combed the void in despair, giving him no relief. (p. 203) 

In imagining how Verheyen could respond to his desperation for relief, Tokarczuk draws on his intense interest in preserving human body parts. Before the amputation, he begs the surgeon to “preserve the removed leg.” (p. 193) The surgeon followed Verheyen’s detailed instructions for preparing his amputated limb by placing it “in a glass vessel filled with a balm of Nantes brandy and black pepper.” (p. 193) Verheyen kept it “on his headboard or stretched scarily out on the table.” (p. 196) Eventually, he looks to it as a possible source of relief. 

Once, in a fit of despair, when the pain and itching were driving him mad, he stood and with trembling hands lit a candle. Hopping on one foot, he moved to the table the vessel with the cut-off leg [rested]…He extracted the limb and in the candlelight tried to locate in it the reason for the pain…He sat down on the floor, stretched his legs out before him, and laid the amputated limb on the place just below his left knee. He closed his eyes and groped for the painful place. His hand touched the cold piece of flesh—but could not reach the pain. (pp. 203-204) 

Verheyen’s maneuvers and observations did not provide him relief. With his medical training, he begins thinking about mechanisms that could be causing this excruciating and frustrating phenomenon. 

What is it that awakens me, when I feel pain and suffering, since my leg has been separated from me and is floating now in alcohol? There is nothing pinching it, no reason for its suffering, no such pain that can be logically justified, and yet it exists. Now I look at it and simultaneously feel in it, in the toes, unbearably hot, as though I were submerging it in hot water, and this experience is so real, so obvious, that if I were to shut my eyes, I would see in my own imagination the bucket of water overly heated and my own foot submerged from toes to ankle. I touch my bodily existing limb in the guise of a lump of preserved flesh—and I don’t feel it. I feel, meanwhile, something that does not exist, it is in a physical sense an empty place, there is nothing there that might give any sensation whatsoever. The thing that hurts does not exist. A phantom. Phantom pain. (p. 208)  

He comes up empty. 

Tokarczuk cannot imagine Verheyen would let the issue lie and accept it simply because he is without an anatomical or pathophysiological explanation. She knows that before he began his schooling in medicine, he was studying theology towards becoming a Catholic priest. In fact, in the book and in his real life, the amputation disqualified him from Catholic priesthood. So, Tokarczuk brings his theological training into thoughts he could have about this phenomenon that is torturing him from spiritual realms, and in this way leaving Verheyen to contemplate the mind / body relationship. He concludes, “The body is something absolutely mysterious.” (p. 209)  

It still is.  

Web image generated with Dall-E 2

Author George Scialabba ascribes his “exceptionally flimsy…shock absorbers” to his “constantly worried” parents (p.3). While studying at Harvard he becomes involved with a strict religious organization. After leaving that group he undergoes a crisis of faith and his first episode of depression. Paralyzed by self-doubt, he drops out of graduate school and begins a cycle of clerical jobs that are beneath his intellectual capability. After many years he gradually wins distinction as a freelance essayist. However, due to his incapacitating symptoms he never has a steady writing job and has difficulty attaining financial security.   

In his introduction, Scialabba tells us that “the pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything” (p.1). As attested to by the notes of his well-meaning psychiatrists and psychotherapists, he has diligently applied himself to a wide variety of treatments. Sadly, if anything he gets worse over time, and eventually requires electroconvulsive therapy.  

The task of wading through more than a hundred pages of treatment notes induces a feeling of helplessness. This gives us a taste of the author’s own experience of his illness. He often seems to get better or worse without rhyme or reason. Diagnoses come and go. At various times he has been called borderline, obsessive-compulsive, narcissistic or schizoid. He himself questions the literary quality of the notes, considering them “anti-writing” (p.7). Nevertheless, persevering through the material does yield insights for the reader.   

For one thing, the notes document changes in psychiatry over the past half century. The early note takers took their time, and their writing is thoughtful and descriptive. Later notes are comparatively terse and center on the patient’s response to medication. The author suggests that the change reflects a greater fear of litigation. The reality is multifactorial. Less attention is devoted nowadays to understanding a patient’s psychodynamics. Insurance companies pay for symptom relief and want documented results.  

Any sense of tedium the reader might feel from reading the author’s mental health records is made up for by his “tips.” Scialabba gives practical suggestions about pharmaceuticals, what to eat, and how to sleep. Sufferers of depression will be pleased to hear about these things not from a doctor, but from someone who has been through the same ordeal.  

In short, How To Be Depressed is a self-help book that is somewhat out of the ordinary, and whose flippant title belies its serious content. It provides an intellectual perspective on a devastating and common disease. 

Publisher University of Pennsylvania Press 
Place Published Philadelphia 
Edition 2020 
Page Count 146 

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

A MacArthur Fellow and author of several acclaimed novels, Antrim has previously published a memoir of his upbringing with his alcoholic mother. In this new memoir, flashbacks of childhood neglect and chaos are juxtaposed with the present day as he takes the reader through the acute phase of his illness: a lengthy hospitalization, a course of ECT, discharge from the hospital, rehospitalization, and eventual stabilization.  

The author considers his condition to be suicide, noting that “depression is a concavity, a sloping downward and a return. Suicide, in my experience, is not that. I believe that suicide is a natural history, a disease process, not an act or a choice, a decision or a wish…I will refer to suicide, not depression” (pp. 14-15).   

The book ends on a hopeful note. After several relationships that might be described as codependent, Antrim meets his current partner, whom he marries. He sees the roof of his building through his window and remembers a certain Friday in April but is comforted by the sound of his wife playing Chopin and Bach on the piano.  

This is an exceptionally brave book. Antrim does not attempt to whitewash his situation in any way. Surely it is humiliating for someone so successful to acknowledge he has been utterly debilitated. He loses track of time. He gains weight and cannot fit into his clothes. His new book is released, but he is in no condition to help promote it. At first, he objects to being called psychotic but eventually it comes as a relief to know he is understood. One Friday in April will be inspirational to others who have suffered to see how an accomplished person is reduced to being allowed to use his razor only under strict supervision.   

At times Antrim touches on the link between mental illness and creativity. If he had hoped the cathartic exercise of writing about his childhood would have stopped his illness he learns otherwise: “Writing had not stopped my dying. (p. 80)” At another point, his friends joke that his diagnosis “might enhance my literary reputation” (p. 115). Finally, in one of the more poignant episodes in the book, Antrim gets a call from the novelist David Foster Wallace and is encouraged to undergo ECT. He has an excellent response to that treatment, but later learns that Wallace has hanged himself.  

While a diagnosis of psychotic depression fits best with the range of symptoms the author manifests, his point about suicide as a distinct disorder is well taken. In fact, the most recent edition of the DSM (Diagnostic and Statistical Manual) took the major step of including Suicidal Behavior Disorder as a “condition for further study.” This corroborates the author’s experience and means that SBD might be included in a later edition. (see also https://www.frontiersin.org/articles/10.3389/fpsyt.2020.499980/full)   

Those who are looking for an exposé or critique of the mental health system will not find it here. Antrim credits his psychiatrists and the hospital with helping him get through an unbearable time. One Friday in April is a book that will give reassurance to people who have endured suicidal thoughts that if they persist they will get better.  

Publisher W.W. Norton & Company 
Place Published New York 
Edition 2021 
Page Count 141 

Web image from Wikicommons
An earlier version of this review was published in the NYU Literature, Arts and Medicine Database 

The narrator in this three-stanza poem observes men in a mental hospital who suffer from what at the time (World War I) was called shell shock and now might be labeled post-traumatic stress disorder. In any case, they are insane; they relive the “batter of guns and shatter of flying muscles.”

For these tortured souls, “sunlight seems a bloodsmear” and “dawn breaks open like a wound that bleeds afresh.” They cannot escape their hideous memories of the warfare. The narrator sees them as living in hell, and he accepts for all society the blame for what has happened to them–we, he says, have “dealt them war and madness.”

Wilfred Owen is recognized as the master poet of the First World War. Writing from firsthand experiences, both in combat and in a hospital recovering from battle fatigue, Owen gave us image after image of how horrible this war was — how the idealized notions of heroism and manly valor meant next to nothing when one was trying to survive gas attacks and bombs dropped from planes. Owen was killed a week before the armistice.

In this poem he opens with a series of questions about who these mental cases are, why they rock back and forth in some kind of purgatory, why they are so tortured with panic and misery. In the second stanza, he answers the opening questions: these are the men whose minds have been ruined by their war experiences, for whom the grotesque carnage of the war was “rucked too thick for these men’s extrication.”

In the final stanza, he explains why these men are so tortured by their memories. And, typical of Owen, he points out that everyone who supported the war contributed to the madness of these mental cases.

📖 Read the poem

The Poems of Wilfred Owen
Wilfred Owen
Publisher: W. W. Norton
Edition: 1986
Editors: Jon Stallworthy
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

Actor Clark Middleton wrote this autobiographical dramatic monologue in collaboration with Robert Knopf. Stricken with juvenile rheumatoid arthritis at age four, Middleton enacts his early painful experience — painful physically and emotionally. He takes us through an adolescence complicated by physical difference, his interaction with medical professionals over the years, and his craving to become an actor. Middleton struggles with the medical establishment, the pain and humor of coming-of-age, and ultimate self acceptance. Eventually, he was able to have both hip replacement surgery and a career in theater and film. The play is funny, poignant, and instructive.

Miracle Mile was performed in New York City in Fall, 1997 at Theater Row. The New York Times review called the play, “an enriching chronicle of a man who refuses to let the world take him at face value.” Middleton performed his monologue at New York University School of Medicine and at other institutions. Clips of a videotape of the theater performance are available at this web site.

Archive Videos from the Play

Actor Information
Clark Middleton (actor/author) performed MIRACLE MILE Off-Broadway in the fall of 1997. He has appeared in Sam Shephard’s CURSE OF THE STARVING CLASS as well as Mr. Shephard’s CHICAGO at the Signature Theatre Company. Clark was in William Hoffman’s AFTER THE ORCHARD and performed MIRACLE MILE at the Invaluable Cape Cod Theater Project. He began his professional career performing with the late Geraldine Page in productions of THE MADWOMAN OF CHAILLOT, PARADISE LOST, and VIVAT VIVAT REGINA. Since that time he has appeared in more than 40 NYC productions, most notably at the New York Shakespeare Festival, The Public Theatre, LaMaMa and Circle Rep, where he appeared with Olympia Dukakis in THE HOPE ZONE. In NYC Clark has directed LONE STAR, OUR DALY BREAD, DOMINO COURTS, CALL IT CLOVER and KIDNAPPED. He also directed MARVIN’S ROOM at The Wayside Theatre in Virginia. Clark can be seen in the films BAIL JUMPER, STORIES FROM NEW YORK, THE CONTENDERS and DON’T SHOOT DARLING. Clark plays the forensics expert Ellis on NBC-TV’s LAW & ORDER. He is a native of Tucson, Arizona and a member of both the Lab Theater Company and the 42nd Street Workshop.

Clark died on October 4, 2020. He was 63 years old.

Director Michael Warren Powell
Leading Actors Clark Middleton
Video Courtesy of Michelle Bouchard
Original Date of Entry 07/12/06

An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).

Web Photo by Alex Radelich