The Sick Child

The sick child is thought to be the artist’s sister. She is not a child but rather a young girl who is lying down or seated, with a blanket over her lower body and she faces a woman who is seated beside her, clutching the child’s left hand. We cannot see the woman’s face – it is turned down as she is bent over in apparent grief. While the painting’s title names the girl as the subject of the painting, it is the grieving woman and her attention to the girl that is particularly striking.

Death and the Child

Death and the Child depicts the anguish of a child who has been confronted with the corpse of her mother lying in bed. The child faces the viewer, hands pressing against her ears – she cannot bear to “hear”/ absorb what she has encountered; her face has an expression of fear and despair

Death in the Sickroom

In Death in the Sickroom several adults are scattered about, some standing, one woman sitting in the foreground; behind her another woman stands facing us. In the back of the room a figure sits on a chair, a blanket draped over her lap – presumably this is Munch’s sister. With his back to the wall an elderly man has both hands pressed to his chest. These individuals have come to help and mourn but they are isolated from each other, which adds to the grimness of the scene.

Image credits: wiki commons

Painting with Empathy: The Expressionist Art of Edvard Munch with Curator Øystein Ustvedt

Russell Teagarden 12.28.23 1827

Edvard Munch’s emotional portrayal of illness and suffering offers profound insights for health professionals and…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Web image by Russel Teagarden

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Why did you write this book?

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

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

What would that look like in practice?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What inspired the book’s title?

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

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

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

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

Web image created from book cover by Medhum.

Most chapters are titled after a medical condition (exceptions are “Hubris” and “Melodrama”). Some of the headings are familiar – Trauma, Infarct, Aneurysm, Meningioma. Other chapter titles flaunt delicious medical terminology that mingles the mysterious and the poetic with nomenclature such as Angor animi, Neurotmesis, Photopsia, and Anaesthesia dolorosa.

Included are riveting accounts of both mundane and seemingly miraculous patient outcomes. One success story involves a pregnant woman losing her sight due to a brain tumor that compresses the optic nerves. Her vision is restored with an operation performed by the author. Her baby is born healthy too. But tales of failure and loss – malignant glioblastomas that are invulnerable to any treatment, operative calamities including bleeding of the brain, paralysis, and stroke – are tragically common. The author describes his humanitarian work in the Ukraine. He admits his aggravation with hospital bureaucracy and is frequently frustrated by England’s National Health Service.

Sometimes the shoe falls on the other foot, and the doctor learns what it is to be a patient. He suffers a retinal detachment. He falls down some stairs and fractures his leg. His mother succumbs to metastatic breast cancer. His three month old son requires surgery for a benign brain tumor.

As his career winds down, the author grows increasingly philosophical. He acknowledges his diminishing professional detachment, his fading fear of failure, and his less-hardened self. He becomes a sort of vessel for patients to empty their misery into. He is cognizant of the painful privilege it is to be a doctor.

The title of Do No Harm is spot-on. After all, this commandment is a crucial caution to all doctors. And for neurosurgeon Marsh, it signifies the restraint he must exercise in his medical decision-making. His approach to the doctor-patient relationship features a gentle medical paternalism that incorporates plenty of honesty and kindness. He writes about his struggle (and occasional clumsiness) with breaking bad news.

His professional life is portrayed as paradoxical – constant anxiety and contagious confidence, phases of futility and strings of inspiring operative accomplishments. The gift of forgiveness, how uncertainty tortures doctors, and the process of dying are significant topics for Marsh. In the last few decades, there has been a proliferation of medical memoirs. Do No Harm rises above them all. The book informs doctors that it’s okay to be vulnerable and fallible, as long as they are also compassionate, truthful, and caring. 

Primary Source Do No Harm: Stories of Life, Death, and Brain Surgery 
Publisher Thomas Dunne Books/St. Martin’s Press 
Place Published New York 
Edition 2015 
Page Count 288 

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

John O’Connor, whom I happened to interview on May 5, explores a similar dynamic unfolding amid today’s psychedelic renaissance—a movement rife with magical thinking that he sees as something of a religious revival—in his delightful and enlightening new book A Short, Strange Trip: An Untold Story of Magic Mushrooms, Madness, and a Search for the Meaning of Life in the Amazon. 

Some Westerners are appropriating sacred plants while divorcing them from the traditions that gave them meaning—“colonizing them in reverse,” as American ethnobotanist Glenn Shepard puts it (p. 211). For example, ayahuasca use, despite widespread belief, may not date back thousands of years. Instead, O’Connor argues that the practice “rarely existed where Indians remained isolated from Western meddling” (p. 222). Its expansion beyond the Río Napo began relatively recently with Jesuit missions in the early 17th century and later accelerated through 19th-century rubber camps along the major river systems of the Amazon Basin. Through Western tourism, ayahuasca has come to be portrayed as “an ancient ritual for slaking our insatiable thirst for Indigenous salvation and/or for increasingly extravagant highs” (p. 223). 

During our meeting, O’Connor told me he does not “think there’s ultimately harm in appropriating a plant if you find it therapeutic, useful, or even life-saving—which a lot of people are reporting these drugs can be.” 

At the same time, he said, “we need to have an honest, good-faith conversation about where these drugs come from, what their actual Indigenous uses are, and what they are.” 

To write the book, which explores humanity’s broader relationship with psychedelics, from ancient religion to modern medicine, O’Connor worked with the Uitoto people to retrace an expedition undertaken some 50 years ago. Into the Colombian rainforest—home to begonias as red as blood and butterflies as wide as hubcaps—ventured scientific researcher Dennis McKenna and his older brother Terence, the visionary whose “tangled beard hung like an oriole’s nest past his chin” (p. xix). Weary of the war on drugs and fueled by utopian fantasies, Terence’s army of psychonauts sought a legendary hallucinogen that would turbocharge their DNA and “hasten a return to our preindustrial and preliterate past” (p. 284). 

In reality, Terence and his disciples did not transform into “eternal hyperdimensional beings” or travel via “flying saucers of the mind… ‘into the plenum of being’” (pp. 94, 30). Nor did they propel “human evolution forward to its next stage” by connecting to “the mind of nature itself” (pp. 284, 11). But they did experience auditory and visual hallucinations that led them, in a manner not unlike schizophrenia, “to adopt a new narrative interpretation of the world” (p. 95). 

Armed with the spore prints they’d brought back from La Chorrera, the McKenna brothers were “among the first, if not the very first, to successfully cultivate magic mushrooms at home, sparking a major leap forward in psychedelic history” (p. 202). In 1976, they published Psilocybin: Magic Mushroom Grower’s Guide; this April, half a century later, President Donald Trump signed an executive order expediting research into the therapeutic benefits of psilocybin and other substances of its ilk. 

O’Connor mentioned that one such mind-altering drug, ibogaine—made from the root of a Central African shrub—has shown promise in treating post-traumatic stress disorder and substance use disorders. 

“That’s great,” he told me, “but it also has a habit of slowing people’s heart rates considerably,” among other life-threatening side effects.  

“People are diving into these treatments as if there are no potential risks,” O’Connor, who teaches journalism at Boston College, added. “They don’t work for everyone—they’re not a magic bullet.” 

The remainder of the interview, which follows, has been edited for length and clarity.  

Why did you choose Terence as the focal point of the book? 

I hadn’t heard of him, and I pride myself on knowing about eccentric, overlooked weirdos from the psychedelic ’60s and ’70s. I was doing a lot of retail therapy online during the pandemic, as were many folks, and I came across his book, True Hallucinations (1989), totally by happenstance. I hadn’t known anything about it, bought it, and put it on the shelf for two years.  

I finally opened it one day and started reading. I had some preconceived ideas without really knowing anything about Terence or his subject. I thought it was probably some hippie-dippy thing about machine elves, and it sort of is that, but that’s not all it is. It’s a great narrative and just fascinating—it just captured me. 

Terence postulated that psilocybin mushrooms “played a crucial role in human evolution, giving our remote ancestors a jolt in language and cognition” and “turning Homo erectus into Homo sapiens.” While there’s nothing in the fossil record to support Terence’s “stoned ape theory,” according to anthropologist Laura Weyrich, advances in proteomics and DNA-sequencing technology could potentially indicate whether ancient hominids at least ate psychedelic mushrooms.  

How plausible do you think stoned ape theory is? 

When I first began looking into it, I was like, “Oh, this is so ridiculous.” I was embarrassed to ask these various paleoanthropologists, archaeologists, and researchers about it. I was like, “Oh my God, I can’t ask this, but I have to.” But it turns out that, as a thought experiment, many of them also found it interesting. It’s not something that I think is ultimately really provable. You could find some tangential scientific evidence, but you’re probably never going to get a smoking gun. 

Terence had a lot of theories—some relatively sane-seeming, like the stoned ape theory, and some completely batshit theories that have no basis in science or reason. But I sometimes liken him to Sigmund Freud, or maybe some of the kookier analytic philosophers, where you read it, it sounds kind of good, and then you get to the end and think, “Well, that’s probably 95 percent bullshit, but it still enriches my worldview.” I feel more enriched for having read it. That doesn’t mean it’s true, and I don’t put much credence in it, but it’s fun to entertain, and I do think it enriches the way I think about the human mind and human possibility. 

You also mention how “what drove [you] to write this book was in part a procession of deaths and their aftermaths” you and your wife endured starting in 2019. Would you elaborate on that? 

About a year into writing the book, my son, who was four at the time, fell ill unexpectedly, out of nowhere. He was in and out of the hospital during those days. It really brought us face to face, for the first time as parents, with real suffering and grief, and with being totally out of control when it came to finding a remedy for him. There was just no help to be found anywhere. I started thinking about grief and suffering, and how much of it was around us.  

Then there was this kind of cascade of deaths—just a lot coming at once over the span of a couple of years. It made me wonder what psychedelics, at least on a therapeutic level, potentially have to offer people: some relief.  

Another thing: My father was, weirdly, at the same time, starting to consider psychedelic-assisted therapy to treat his depression and longstanding addiction to alcohol. Maybe a year before, I’d given him Michael Pollan’s book, How to Change Your Mind: What the New Science Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (2018). Because my dad had been in and out of therapy, rehab, and 12-step programs for many years, I was like, “I don’t know if you’ve heard of this, but I’ve been reading about non-traditional approaches to treating alcohol addiction, including psychedelics.” I don’t think he ever read it, but it did start a conversation between us. 

What surprised you most while researching the book? 

Reading Terence, I hadn’t realized that psilocybin mushrooms were not indigenous to La Chorrera—that they were essentially a foreign import [1], and not something used by the people there, certainly not by shamans. 

Another revelation was what “shamanism” actually looks like in the Colombian Putumayo. Terence talked a lot about this sort of psychedelic shamanism. A lot of people do today, too. But it’s just not at all what it seems to be. The Indigenous perspective on and use of things like ayahuasca, or yagé, and other psychedelic plants—at least in the Putumayo, where Terence and Dennis spent much of their time—is vastly different from how I think they’re generally understood or used in the U.S. These substances were generally not used for healing. Until European contact with Indigenous peoples throughout the Amazon Basin, ayahuasca was mostly used in the hunt—to have luck in finding animals—or sometimes to find lost objects or communicate with family members or other tribe members over long distances. But it was definitely not a therapeutic application. That’s starting to shift a little bit now, though, because of this strange sort of cross-pollination that happens so often in history where it’s now being fed back into an Indigenous context. 

I think I went into the book as something of a Terence fanboy. I cooled on him a bit once I spoke with Colombian anthropologists and ethnobotanists and realized how taken out of context many of his proclamations were on psychedelics and the “shamanic” experience. But, by the end, I sort of warmed to him again because I realized that his ultimate project, I think, was really about human wellness and flourishing. I think that’s what he wanted ultimately, even if he went about it in a strange, myopic way focused almost exclusively on the psychedelic experience through psilocybin mushrooms. That’s where I part ways with him. I think the best place from which to grapple with grief, loss, and suffering is through love, tenderness, and compassion—not through machine elves at the end of history, which was, more or less, Terence’s take. 

I was also interested in your discussion of “diagonalism”—what scholars William Callison and Quinn Slobodian characterize as the social-distress-born alliances between the far left and the far right uniting wellness gurus, anti-vaxxers, and conspiracy theorists. 

I was just reading an article by the American political scientist Francis Fukuyama; he calls it this horseshoe meeting of the minds—this ideological vortex where people with otherwise totally divergent political opinions are meeting in the middle on certain issues. The far left, the Make America Healthy Again movement, the Multidisciplinary Association for Psychedelic Studies—even just the friendship between [MAPS founder] Rick Doblin and former Texas Governor Rick Perry [co-founder of the nonprofit Americans for Ibogaine], who had one of the most conservative legislative agendas in recent memory. That friendship seems genuine—and maybe even necessary to advance these drugs beyond their current legal status. 

In 2023, MAPS hosted the world’s largest psychedelic conference, which you describe as laden with snake oil pseudoscience and lacking in diversity, equity, and inclusion. Almost a year later, an FDA advisory panel rejected MDMA-assisted therapy for PTSD, citing safety concerns and questions about data validity. Critics alleged that MAPS’ drug development arm failed to disclose data showing sexual misconduct by therapists and increased suicidality among trial participants. A former MAPS volunteer called MAPS an exploitative and abusive cult that functions “more like a religious movement than a scientific organization.” Similar concerns emerged at The Johns Hopkins Center for Psychedelic and Consciousness Research. An ethics complaint accused founding director Roland Griffiths of “acting as a ‘spiritual leader’ rather than a scientist” and influencing participant outcomes through religious symbolism. 

Additionally, a Columbia psychiatrist reviewing the field noted a relatively high rate of  irritability, anxiety, insomnia, and other adverse events, and called for more “rigorous assessment” of psilocybin-assisted therapy.  

How do we balance the potential of psychedelics to promote empathy and well-being with the risks? 

Terence said a lot of completely bullshit things about psychedelics—even dangerous things at times. You see that in the movement today, where a lot of these wild, unsubstantiated claims are being made about drugs that, yes, have real healing potential for many people, but for others, such as my father, don’t work at all—and arguably cause more harm than good. 

We should be sane and sober about this. We can champion these drugs while still having a lucid conversation about their efficacy, limitations, and safety concerns. 

[1] One of my favorite passages from the book is “Darkly gilled, with distinctive golden halos and pink veils around slender stems the color of bruised flesh, they were easily identifiable as Psilocybe cubensis… Likely brought to the Americas by Spanish missionaries via the dung of zebu cattle—rangy saltwhite beasts with enormous, scythe-like horns—Psilocybe did especially well in the humid pastures of La Chorrera. Amazonian shamans, who knew more about psychoactive plants than anyone on earth, had no use for these foreign imports. To Terence, however, they were living manifestations of the divine” (p. xx). 

A Short, Strange Trip: An Untold Story of Magic Mushrooms, Madness, and a Search for the Meaning of Life in the Amazon 
John O’Connor 
New York: Sourcebooks 
2026 

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

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 

Carrie Coon, Letts’ wife, plays Agnes White, a lonely server living in an Oklahoma motel who falls in love with Peter Evans (Namir Smallwood), an AWOL Gulf veteran. Peter becomes increasingly convinced that he is the subject of clandestine experiments, and that he is infested with government-planted bugs. These bugs are, of course, invisible, yet he drags Agnes with him into a seeming folie à deux—a bedlam of flypaper, aluminum foil, and bug zappers.  

Peter’s delusions (and, in turn, Agnes’s) eventually cross a line into a realm in which logic no longer applies. By spilling so far into excess, even occasionally veering into bizarre spoofiness, Bug risks trivializing Peter’s paranoia—a risk especially fraught now that the part is played for the first time by a Black actor.  

Initially, Peter cites a real case of government experimentation: the Tuskegee Syphilis Study, in which poor Black sharecroppers were never told they had syphilis. The experiment ran from 1932 until 1972—long after penicillin became the standard treatment in the mid-1940s. To observe how the disease naturally progressed, researchers deliberately withheld the antibiotic, ending the study only after a press leak. 

This gross violation of ethics is widely believed to have damaged Black Americans’ trust in the medical establishment. But according to medical ethicist Harriet A. Washington [1], “that narrative is flawed and untrue.” While Tuskegee certainly contributes to that distrust, the larger impetus is “four centuries of abuse in the medical arena,” which Washington chronicles in her 2007 book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. “In fact, one study indicated that African Americans who had never heard of Tuskegee were more likely to fear vaccine administration and medication design.” 

What if Bug had dialed down Peter’s paranoia and explored it within this broader historical context instead of reinforcing the singularity of Tuskegee? Overemphasizing Tuskegee because of its infamy (or because of one’s ignorance) serves to obscure other historical ethics violations as well as systemic racial inequities that persist today. For instance, what if Peter struggled to access mental healthcare because of structural barriers? 

In her 2021 book Carte Blanche: The Erosion of Medical Consent, Washington mentions an experimental anthrax vaccine that soldiers were required to receive beginning in 1998. “Soldiers of all races were affected,” she writes, “but Blacks were overrepresented because they constituted 12.3 percent of Americans, but were 24.5 percent of the 1.7 million ground troops deployed to the Gulf in 1990 and 26.2 percent of Army reservists in 2001—twice their representation in the population at large, and so at twice the risk of being forced into military research.” 

Many service members reported autoimmune conditions after getting the jab, but the Pentagon attributed their symptoms to “emotional issues,” Washington continues. “The military subsumed vaccine-related illnesses under the nebulous symptomatology of ‘Gulf War Syndrome.’” What if Bug had dramatized that ‘nebulous symptomatology’? 

Peter also references another example of government research: the Edgewood Arsenal experiments. After World War II, the U.S. Army Chemical Corps tested chemical weapons on American soldiers at a secluded research facility on the Chesapeake Bay, exposing volunteers to more than 250 different chemicals, including LSD, mustard gas, and sarin. The studies ended after researchers were accused of ethical transgressions, including issues with informed consent and recruitment. Archival footage, unearthed in a 2022 documentary, shows men “going temporarily blind, reduced to babbling or completely dysfunctional logs, or worse, ready to commit violence upon themselves.” [2] 

Washington argues in Carte Blanche that “the medical crimes that were denounced and punished at Nuremberg have American analogues.” 

“Although not perfect parallels,” she notes, “they share a violent, nonconsensual, and largely racial disparate nature, as well as the frequent invocation of military expedience.” 

In this light, Peter’s condemnation of his doctors as neo-Nazis feels less outlandish than the play permits. Letts may hint that Peter is not entirely psychotic—that his madness holds some truth. But that seed never grows.  

The play ultimately bubbles over (spoiler alert: self-harm, violence, and fire). A future iteration of the three-decades-old play, if there is one, might benefit from taking Peter’s delusions more seriously—and leaving open the possibility that they are, in fact, real. 

Bug will get under your skin, but to what end? 

Bug, through March 8th at the Samuel J. Friedman Theatre in New York; manhattantheatreclub.com/shows/2025-26-season/bug/.  

[1] “Harriet A. Washington on the Narrative Around Vaccine Hesitancy in the African American Community: In Conversation with Andrew Keen.” Keen On from Literary Hub, 19 Mar. 2021, lithub.com/harriet-a-washington-on-the-narrative-around-vaccine-hesitancy-in-the-african-american-community/. 
[2] Simonpillai, Radheyan. “‘It Affected a Great Number of People’: Inside the World of Shocking Military Drug Experiments.” The Guardian, 9 June 2022, theguardian.com/tv-and-radio/2022/jun/09/dr-delirium-and-the-edgewood-experiments-documentary. 

Web image by Matthew Murphy.

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

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

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

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

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

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

Miscellaneous 

Beloved
Toni Morrison

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

Publisher Vintage 
Place Published United States 
Edition 2004 
Page Count 324 

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

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