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.

The house sits at the foot of a spring-green mountain, painted over with long cascading strokes of darker green, giving the impression of a verdant and peaceful setting. Contrast this to the brown ridge where the figure is sitting, huddled in a long sleeve jacket, hands tucked into pockets. The ridge is barren except for a single tree that is mostly bare branches with sparse pale-pink leaves.

Matthew Wong was a rising young painter who died of suicide on October 2, 2019. In a moving obituary by the New York Times, his mother explained that Mr. Wong “was on the autism spectrum, had Tourette’s syndrome and had grappled with depression since childhood.” This helps to explain the sense of isolation and longing in the painting, depicted by the solitary figure on a barren ridge, looking back at a house in lush green surroundings. The figure also appears to be physically cold, wrapped in long sleeve coat, hands tucked in pockets, with no skin showing, but is sadly separated from shelter by an icy white distance. This dynamic, amidst a landscape of majestic mountain rising into star-crowded sky, gives a sense of melancholy beauty and loneliness.

The title of the painting, “See you on the Other Side,” can be interpreted in numerous ways. Mr. Wong is known for incorporating mythical elements into his work, so is this the beginning of the hero’s journey? If the tree in the foreground is interpreted as being laden with pale pink flower buds, there is a sense of hope and promise that the figure is leaving home and will return triumphant on the other side. But the tree can also be seen as a representation of fall transitioning into winter, hanging onto a few withered leaves, as the last bright red autumnal leaf blows away. Is the figure heading away from the verdant house and mountain into winter, the season that classically symbolizes death? Does the other side refer to an afterlife? A third interpretation to consider is that the figure is not leaving the house, but actually trying to get there. In this case, on the other side would refer to crossing the vast white expanse where no path is marked and no help is in sight.

View the painting at Museum of Fine Arts Boston ➔

Matthew Wong’s Biography: www.matthewwongfoundation.org/biography
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image from www.matthewwongfoundation.org/

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

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

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

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

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

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 

Kline opens with the shocking practice of team doctor Larry Nassar (1963-), pedophile and serial abuser of the gymnasts under his care who successfully took him down in 2017. He is serving decades in prison, where he was stabbed multiple times in 2023. She continues with the story of the Johns Hopkins University gynecologist Nikita Levy (1959-2013) who secretly photographed (or filmed) his patients’ genitalia with cameras concealed in pens that he wore on a lanyard around his neck. Abruptly fired when the story came to light, Levy died by suicide in 2013. Two years later 9000 victims were awarded a class-action settlement of $190M.

 It is not surprising, albeit horrifying, that such abuse could emerge in a medical specialty that centers on the most intimate aspects of women’s healthcare.  In a sequence of readable chapters, each of which could stand alone, Kline examines medical achievements in women’s health that could be (and have been) told in triumphalist tones: the speculum, gynecological surgery, the Pap smear, and oral contraceptives. All were invented by men. She also includes marriage counseling and patients as lay instructors in pelvic exams, both initiatives also promoted by men.

Without denying the potential value of these innovations, Kline brings every chapter into the present with the voices and actions of women who object because of painful incursions upon their bodies, denial of their humanity, and distortions of power. Her sources include archives, journals, histories (many written by women scholars), interviews, patient stories, and artistic creations—objects, music, films, poetry. Issues of gender, race, and class pervade the analysis.

The nineteenth-century inventions of the much-maligned J. Marion Sims (1813-1883) end with the 2018 dismantling of his Manhattan statue and the 2022 unveiling, in Montgomery, Alabama, of Michelle Bowder’s Mothers of Gynecology in honor of the three slaves who had been his research subjects. The chapter on Robert Battey (1828-1895) cites the critical secondary literature on how his procedure to remove ovaries by the vaginal route became vastly overused for all female complaints, even mental illness; however, it also draws upon his papers, kept in Atlanta, allowing the reader to comprehend how his initial motivation was to end the menstrual cycle for patients.

Similarly, Kline explores the previously unexamined papers including numerous drawings and photographs of R.L. Dickenson who strove to comprehend female sexual response while purporting to avoid prurience. As much as we are put off by the excruciating details of his oeuvre, letters from grateful patients demand reconsideration of his efforts to understand female sexuality.

The Pap test, which detects early cervical cancer, and the birth-control pill both advanced women’s healthcare. Yet they each prompted reactions from lay women: the failures and inaccessibility of Pap testing and consequent delays in diagnosis, resulted in cervical-cancer survivors‘ organizations; the impersonal implementation and insistence upon regular pelvic examinations spurred the vaginal self-examination movement. Kline lays out the medical achievements and plunges into the social reactions through interviews with the founders and leaders of these activist groups, tracking them down internationally. They express the militant goal to avoid the gynecologist (as if they are all brutal), and the unalloyed joy of seeing one’s own cervix (without the benefit of cytology). Some activists called for men to be banned from the specialty. One wonders if the strident anger and hostility directed at male professionals, many of whom try to practice with compassion and care, may well have incited previously unfelt, reactionary attitudes in the practitioners.

The use of surrogate patients for teaching history-taking and physical examination was proposed and advocated by Harold Barrows in the mid-1960s. A decade later, once academic and professional gynecology accepted the complaints of activists, it followed the trend and began to engage lay women as teaching assistants on how to perform pelvic examinations. Kline outlines Robert Kretschmar’s extension of the trend to pelvic examination at the University of Iowa. She also describes the Pelvic Teaching Program of Harvard and its involvement of the Women’s Community Health Center (WCHC). Even there, we read of pushback and disillusionment as relationships soured. What kind of a woman would do that? – and why? The originally enthusiastic female participants were underpaid and treated as passive objects rather than instructors. Prostitutes had been engaged, as well as gender activists who “started feeling like [they] were in the same positions as are prostitutes….and then started saying ‘Yeah, we are. We are.’” (p. 206) The professors eventually learned to quietly observe, but the students themselves tainted the experience with sexual inuendo and disrespect. Kline provides statistics on how widely lay instructors are used today.

Also using statistics, she exposes today’s teaching of the pelvic examination on anesthetized women who have not given consent. Although the American Association of Medical Colleges deemed the practice unethical in 2003, it is still widely used, most often on racialized, “public” patients.

Kline also highlights the medical, social and financial obstacles to care for transgender people.  Citing surveys from 2015, she reminds readers that most medical students receive no training on care of trans people and that trans men should receive Pap tests but most do not, because of their own discomfort and the ignorance of health care professionals.

Under Kline’s gaze, the benefits of each medical achievement tend to unravel in clinical practice. She rarely outright condemns or criticizes the physician actors; however, she uses irony, targets hypocrisy, and never fails to highlight the opportunities for self-promotion within the benefits that they provided to their patients. Just as she observes gynecologists second-guessing or failing to believe their patients, she views their own stated motives and goals with skepticism. Instead, she allows the male physicians to skewer themselves in their own words with choice quotes. Believing his patients’ pains were psychological, James C. Wood described how he cleared a clogged ward: “’I wanted their beds above all things for real surgical cases, and I knew not one of them wanted to be cut’ So he started scheduling them for various surgeries and, within a week, all ten beds were ‘well emptied for legitimate hospital use’” (p. 102).

Issues of power, trust and consent underpin the fallout of these stories and explain why many women avoid pelvic examination despite its undeniable advantages. In a counterpoint to the miserable tales of criminals at her opening, Kline closes with a patient’s tribute to a sensitive gynecologist on Martha’s Vineyard. The patient has long suffered from an iatrogenic injury owing to the diethylstilbestrol (DES) treatment given to her mother during pregnancy. Her doctor, Dan Pesch, listens well, comprehends her justified fear, grants her control over decisions, and yet manages to wield all the advances of last two centuries to catch her cancer early. Compassion, Kline observes, “can literally save lives.”

Now—will she next expose the hidden history of the prostate exam?

Exposed: The Hidden History of the Pelvic Exam
Wendy Kline
Cambridge and Hoboken: Polity Press, 2024.