Tag: Sigmund Freud

Two Books about Mind–Body Medicine

Two of my library reads from this month were about different aspects of mind–body medicine. I expected them to overlap more than they did, actually, and hoped that the second might serve as a sort of well-written rebuttal to the first, but in the end they stayed in different camps: the first is about psychosomatic illness and psychiatric treatment, while the second is about the placebo effect and how alternative and holistic treatment strategies might be complementary to orthodox medical approaches. Both gave me a lot to think about.

It’s All in Your Head: Stories from the Frontline of Psychosomatic Illness

By Suzanne O’Sullivan

all-in-your-headO’Sullivan is a UK-based neurology consultant. I picked this up on a whim because I knew it had won the Wellcome Book Prize, as well as the Royal Society of Biology General Book Prize. The conditions she writes about go by many names: psychosomatic illnesses, conversion disorders, or functional conditions. In every case the patients have normal neurological test results – they do not have epilepsy or nerve damage, for instance – but still suffer from seizures or lose the use of limb(s). Their symptoms have an emotional origin instead. Many of her patients are outraged by referral to a psychiatrist, as if they’re being told they’re making it all up, but it’s actually a holistic approach: acknowledging the influence the mind has on how we feel.

Along with cases from her own career, the author writes about early doctors who developed the science of conversion disorders, including Jean-Martin Charcot and Sigmund Freud. I read the book very quickly, almost compulsively; these are fascinating stories for anyone who’s interested in medical mysteries. That’s in spite of the fact that O’Sullivan does not strike me as a natural storyteller: her accounts of patients’ cases are often no more than just one thing after another, and in reports of her own conversations with patients she comes across as robotic and not always very compassionate. Ultimately I believe she does empathize with those with psychosomatic illnesses – otherwise she wouldn’t have written a whole book to illuminate their plight – but it would have taken the writing skill of someone like Atul Gawande for this to be a better book. I’m somewhat surprised it won a major prize.

Note: Chapter 7 tackles CFS/ME/fibromyalgia. These are controversial fatigue disorders, and O’Sullivan is aware that even mentioning them in a book about psychosomatic illnesses is “foolhardy to say the least.” I don’t think what she actually has to say about these conditions is offensive, though (and I say that as someone whose mother struggled with fibromyalgia for years). She allows that there may be physical triggers, but that emotional wellbeing and traumatic experiences or regular stress cannot be overlooked.

Chew on this: “More than seventy per cent of patients with dissociative seizures and chronic fatigue syndrome are women.” The author’s best guess as to why this is? “On the face of it, women turn their distress inward and men turn it outward.”

My rating: 3-star-rating

 

Cure: A Journey into the Science of Mind over Body

By Jo Marchant

cureIn this absorbing and well-written work of popular science, Marchant, a journalist with a PhD in genetics and medical microbiology, investigates instances where the mind seems to contribute to medical improvement: the use of placebos in transplant recipients, hypnosis for IBS patients, virtual reality to help burn victims manage pain, and the remarkable differences that social connection, a sense of purpose, meditation and empathic conversation all make. On the other hand, she shows how stress and trauma in early life can set (usually poor) people up for ill health in later years. She also travels everywhere from Boston to Lourdes to meet patients and medical practitioners, and even occasionally proffers herself as a guinea pig.

A relentless scientist, Marchant is skeptical of any claims for which there is no hard evidence, so when she acknowledges that there’s something to these unusual treatments, you know you can believe her. As Jeremy Howick of the Centre for Evidence-Based Medicine, Oxford puts it, “I think it’s more important to know that something works, than how it works.” I finished the book feeling intrigued and hopeful about what this might all mean for the future of medicine. The problem, though, is that most medical trials are funded by big pharmaceutical companies, which won’t be supportive of non-traditional methods or holistic approaches.

My rating: 4-star-rating


Do these books appeal to you? Do you have any experience of psychosomatic illness or mind–body medicine?

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German Lit Month: The Tobacconist by Robert Seethaler

I don’t participate in a lot of blogger challenges (though I’ll be doing “Novellas in November” on Monday); it’s more of a coincidence that I finished Austrian writer Robert Seethaler’s excellent The Tobacconist (translated from the German by Charlotte Collins) towards the end of German literature month.

You may recall that I read Seethaler’s previous novel, A Whole Life, on my European travels this past summer, and didn’t think too much of it. I’d read so much praise for its sparse style, but I couldn’t grasp the appeal. Here’s what I wrote about it at the time: “This novella set in the Austrian Alps is the story of Andreas Egger – at various times a farmer, a prisoner of war, and a tourist guide. Various things happen to him, most of them bad. I have trouble pinpointing why Stoner is a masterpiece whereas this is just kind of boring. There’s a great avalanche scene, though.”

tobacconistBut I’m very glad that I tried again with Seethaler, because The Tobacconist is one of the few best novels I’ve read this year, and very much a book for our times despite being set in 1937–8.

Seventeen-year-old Franz Huchel’s life changes for good when his mother sends him away from his quiet lakeside village to work for her old friend Otto Trsnyek, a Vienna tobacconist. “In [Franz’s] mind’s eye the future appeared like the line of a far distant shore materializing out of the morning fog: still a little blurred and unclear, but promising and beautiful, too.”

Though the First World War left him with only one leg, Trsnyek is a firebrand. Instead of keeping his head down while selling his cigars and newspapers, he makes his political opinions known. This sees him branded as a “Jew lover” and persecuted accordingly. One of the Jews he dares to associate with is Sigmund Freud, who is a regular customer even though he already has throat cancer and will die just two years later.

Especially after he falls in love with Anezka, a flirtatious but mercurial Bohemian girl, Franz turns to Professor Freud for life advice. “So I’m asking you: have I gone mad? Or has the whole world gone mad?” The professor replies, “yes, the world has gone mad. And … have no illusions, it’s going to get a lot madder than this.”

Through free indirect speech, the thought lives of the various characters, and the postcards and letters that pass between Franz and his mother, Seethaler gradually and subtly reveals the deepening worry over the rise of Hitler and the situation of the Jews. This novel is so many things: a coming-of-age story, a bittersweet romance, an out-of-the-ordinary World War II/Holocaust precursor, and a perennially relevant reminder of the importance of finding the inner courage to stand up to oppressive systems.

Monument for the victims of Nazi Terror at the former Gestapo headquarters in the Hotel Metropol, Vienna. By Gryffindor (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons.
Monument for the victims of Nazi Terror, former Gestapo headquarters in the Hotel Metropol, Vienna. By Gryffindor (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)%5D, via Wikimedia Commons.
Freud and his family had enough money and influence to buy their way to England. So many did not escape Hitler’s regime. I knew that, but discovered it anew in this outstanding novel.

Some favorite passages:

Dear Mother,

I’ve been here in the city for quite a while now, yet to be honest it seems to me that everything just gets stranger. But maybe it’s like that all through life—from the moment you’re born, with every single day, you grow a little bit further away from yourself until one day you don’t know where you are any more. Can that really be the way it is?

And as more than twenty thousand supporters bellowed their assent into the clear Tyrolean mountain air, Adolf Hitler was probably sitting beside the radio somewhere in Berlin, licking his lips. Austria lay before him like a steaming schnitzel on a plate. Now was the time to carve it up. … People were cosseting their faint-hearted troubles and hadn’t even noticed yet that the earth beneath their feet was burning.

(from a letter from Mama) Just imagine, Hitler hangs on the wall even in the restaurant and the school now. Right next to Jesus. Although we have no idea what they think of each other.

Freud: “Most paths do at least seem vaguely familiar to me. But it’s not actually our destiny to know the paths. Our destiny is precisely not to know them. We don’t come into this world to find answers, but to ask questions. We grope around, as it were, in perpetual darkness, and it’s only if we’re very lucky that we sometimes see a little flicker of light. And only with a great deal of courage or persistence or stupidity—or, best of all, all three at once—can we make our mark here and there, indicate the way.”

My rating: 5-star-rating


Happy Thanksgiving to all my American readers! In previous years we’ve been able to find canned pumpkin in the UK to make a pumpkin pie, but alas, this year there have been supply issues (my husband blames Brexit). Nor can we find a real pumpkin – they disappear from the shops after Halloween. Without pumpkin pie it doesn’t feel much like Thanksgiving.

At any rate, here’s a flashback to the seasonal posts I wrote last year, one about five things I was grateful for as a freelance writer (they all still hold true!) and a list of recommended Thanksgiving reading.

The Violet Hour by Katie Roiphe

I don’t believe that you can learn how to die, or gain wisdom, or prepare, and the work I have done on this book has, if anything, confirmed that suspicion, but I do think you can look at a death and be less afraid.

violet hourThe subtitle – “Great Writers at the End” – gives you a hint of what to expect from this erudite, elegiac work of literary biography. In a larger sense, it is about coming to terms with the fear of death, one of the last enduring Western phobias.

Roiphe was a sickly, morbid child. After a serious, extended case of something like pneumonia, she had half a lung removed, and her chosen reading was books about Armenian genocide. Although she was convinced she was going to die at 12, it was only a blip; her next significant encounter with death was her father’s cardiac arrest at age 82. Once again, she was utterly unprepared. In investigating six great authors’ deaths, Roiphe is not so much looking for sage tour guides to the underworld as asking how one faces and narrates death.

Katie Roiphe (from her Goodreads page)
Katie Roiphe (from her Goodreads page)

To start with I was skeptical about Roiphe’s set of chosen writers. Between Susan Sontag, Sigmund Freud, John Updike, Dylan Thomas, Maurice Sendak and James Salter there’s no class or racial diversity, and the gender balance is poor. Yet as I read on I set these quibbles aside. There are literally hundreds, maybe thousands of subjects Roiphe could have chosen, so in a sense the particular authors discussed here are arbitrary. She’s eschewed more obvious candidates like Christopher Hitchens, probably because he wrote enough about his own impending mortality himself. The criteria were probably as plain as this: an author who meant something to Roiphe, left a lot of documentary evidence, preferably had some living descendants and colleagues to interview, and whose death was drawn out enough that s/he had time to wrestle with the thought of it in writing.

Starting each chapter with the vigil at an author’s deathbed in a hospital room or at home, Roiphe skips back and forth in time to pinpoint where illness and death cropped up in that author’s life and work. For Susan Sontag, dying at New York’s Sloan Kettering in 2004, it was her third bout with cancer. A final extreme intervention, a bone marrow transplant at Seattle, had recently failed. Still Sontag shirked the notion of death, refusing even to talk about it. Work was how she had always transcended the specter of death – by writing books like Illness as Metaphor and inserting scenes of false death into her fiction – and now it was all that kept her going. Perhaps, Roiphe theorizes, there was a kind of solipsism at the heart of Sontag’s denial of death: she just could not believe that anything would continue existing without her. Well before her first experience of cancer in the 1970s, she wrote in a notebook: “Too abstract: death. Too concrete: me.”

Susan_Sontag,_Cimetière_du_Montparnasse
Susan Sontag’s grave at the Cimetière du Montparnasse, Paris. (By Wikimedia Commons / Mu (Own work), via Wikimedia Commons.)

One might expect Freud to have been more disciplined about the business of dying, what with his theory of Thanatos (the death drive) and his frequently professed acceptance. However, as Roiphe emphasizes, it is one thing to say you accept death, and quite another thing to actually accept it. In Freud’s case, his refusal to give up cigars despite painful throat cancer and 33 oral surgeries flew in the face of his otherwise rational methods. Cigars were his only vice, he shrugged. Is a cigar just a cigar, or are there overt sexual connotations? For Updike, sex was like Freud’s cigars: sensual evidence that life goes on. Adultery, a frequent theme in his fiction, was perhaps an unconscious strategy for ‘cheating’ death. It was only after his diagnosis with lung cancer that death replaced sex as the central obsession of his work. His last book, like his first, would be poetry: Endpoint, one last valiant effort before death.

Freud with one of his beloved cigars, 1922. Max Halberstadt [Public domain], via Wikimedia Commons.
Freud with one of his beloved cigars, 1922. Max Halberstadt [Public domain], via Wikimedia Commons.
I found the Updike chapter the most absorbing, even though I’ve never read any of his work. (Like Joyce Carol Oates, he was so darn prolific I have no idea where to start.) Prior familiarity with the author in question is neither here nor there, though: you learn everything you need to know from Roiphe’s biographical treatment, and thematic threads are strong enough to lead from one to another. Self-destructive behavior, compartmentalizing life, turning to work or sex to ward off depression, ignoring signs of mortality like serious illness and others’ deaths – we all employ hypocritical strategies, and these authors are no different. Even Thomas’s “Rage, rage against the dying of the light,” resistant as it might sound, was actually delivered in a lulling tone of resignation when he read it aloud, Roiphe reveals.

Each chapter is its own microcosm. The author herself only appears in the prologue and epilogue; in between, although she obviously interviewed survivors (and Salter, who died before he could read the finished book), she edits herself out so we can be right there with the subject. There’s no distance at all. That sense of intimacy is clearest in the chapter-heading photographs of the authors’ (posthumously?) empty studies. These are haunting images. Look at Sendak’s desk covered in paints and drawings, slippers carefully waiting underneath; a cardigan on the back of the chair – there’s such a sense of life. The life continues in the work.

None of these authors got death perfectly right. Several of them fought it right to the end; several of them veered towards faith despite a lifelong antipathy to religion; several of them were ultimately taken aback by the simple realization that they, too, were mortal. Roiphe discovers no magic formula for how a writer should do death. Despite their contradictory approaches, though, all her subjects had the same destination:

here’s what I learned from the deaths in this book: You work. You don’t work. You resist. You don’t resist. You exert the consummate control. You surrender. You deny. You accept. You pray. You don’t pray. You read. You work. You take as many painkillers as you can. You refuse painkillers. You rage against death. You run headlong toward it.

In the end the deaths are the same. They all die. The world releases them.

This would be an ideal book for fans of Olivia Laing (see my review of The Lonely City) or Julian Barnes’s Nothing to Be Frightened of. What Roiphe observes of Sendak’s habit of drawing the dead and dying could equally be applied to The Violet Hour: it’s about seeing the beauty in what terrifies you. One of my top few nonfiction reads of 2016 so far.

With thanks to Grace Vincent of Virago for sending a review copy. The Violet Hour releases today in the UK; it was published on March 8th in the States by The Dial Press.

My rating: 5 star rating