The Storm at the Door – Stefan Merrill Block (2011)

Based on a true story from his family, author Stefan Merrill Block has written an intriguing (and slightly confusing) story about how mental illness affected one East Coast family back in the 1960’s. Block’s grandfather is the subject of the novel, and it is he (and his possible bipolar disorder) that form the foundation of the plot. Mental illness of any sort was never mentioned with many families (and still isn’t in some cases), and was often seen as a source of shame and something to be hidden. So when Frederick Merrill, the author’s grandfather, showed signs of being unpredictable and having poor impulse control in his behavior, one particular event leads his wife, Katherine, and her family to have him voluntarily committed to a fictional mental hospital based on the real-life McLean Hospital. However, even though Frederick was “voluntarily” committed, he cannot be released when he want to go, having to wait until the doctors at the hospital believe he is “better.” However, there is the problem of how to prove you are not mentally ill when you don’t know what your illness really is. How do you know how to be sane?

So, Frederick’s original commitment turns into a months-long endeavor that leaves Katherine in the difficult position of raising their three daughters alone, with little money, and with one parent existing out in a cloud of unmentionable illness. It was the big Elephant in the Room syndrome, as all the family and friends knew that Frederick had been ill. It was just not acceptable (or polite) to ever mention it more than “he had a nervous breakdown” or (more likely) “he went to have a rest”. (Very similar to how mental illness and/or addiction is treated in the case of celebrities nowadays.)

So Katherine struggles to maintain an air of normalcy in a very abnormal situation and without knowing what was really going on with her husband. The clinic doctors kept Frederick’s health information very close to their chests, and would not keep her informed as to his progress, and both Frederick and Katherine were forbidden to contact each other for “therapeutic reasons”. This story has been compared to “One Flew Over the Cuckoo’s Nest” and it is quite similar in that way in its depiction of how power plays a big role in mental health care.

It’s a compelling story of how one family tries to cope with an unmentionable illness that has no time line, no name and no particular symptoms. Frederick himself is not told his diagnosis, and realizes that he has little power to get a release from the hospital by himself – only by “playing the game” that the doctor in charge requires him to do. It’s quite remarkable how circular this power game is – the doctor refuses to let Frederick or his family know what is going on but they know that the only way to get a release is to make the doctor happy. But how? He is in charge of a game with unknown rules, unknown goals, and rules that keep changing.

There are some good descriptions of some of Frederick’s hospital co-patients, and it is very sad to think that this story (and thus the description of the mental treatments) was close to the truth. Frederick is forced to have ECT with the hopes of him forgetting a transgression that he witnessed between his doctor and a nurse. Unruly patients are sometimes shuttled off to have lobotomies when they become difficult, and a power-hungry crew of young and untrained male orderlies retain control of the unit once the doctors have left for the day.

The title, “The Storm at the Door”, refers to the idea (I think) that however safe and sound your own home is inside, once you step out of the door, it’s a harsh world. It might also refer to the idea that mental illness is also just outside the door for some people and families, whether they want to admit it or not.

Structurally, this book worked pretty well once I got the hang of it. Chapters alternate the omniscient POV of a present-day grandson (the author) looking back at his grandfather Frederick (during his time as a patient) and then looking at his grandmother Katherine as she tries to cope with the changes and lack of information over the years. It was also in present tense (which can be annoying but wasn’t in this case).

A pretty good read, and thanks to Rachel at Book Snob  for sending it to me.

Diary without Dates – Enid Bagnold (1917)

A loose and unstructured diary that tells the story of a life as a VAD in a military hospital during WWI. The name of the hospital and its location are kept vague, probably due to security concerns, but Bagnold still got widely criticized for this screed against the hospital administration. (It was later confirmed that she was working at the Royal Herbert Hospital in Woolwich.)

This is a day-to-day account which seems to flow from one day to the next, from one week to the next with no clear delineation of days or other traditional calendar markers. Seasons are acknowledged, and night and day, but apart from that, few clues are given about time which seems to give a dreamy quality to the document. It’s rather stream-of-consciousness which was rather cutting edge back then.

Bagnold was a Voluntary Auxiliary Detachment person and worked for the British Red Cross. VADs were trained to do first aid and very basic nursing care in the numerous military and convalescent hospitals that sprung up during the Great War (a la Downton Abbey). Bagnold came from a very privileged background, growing up in Jamaica with titled parents and coming to London to go to art school, and thus, she is very aware of the important role that social class distinctions made at this time.

Being a VAD, she feels rather peripheral to the whole hospital situation: she is very limited in what she can provide skill-wise and also resource-wise, and so she views the daily life from a step removed which enables her to look with a certain level of dispassion at things. She finds the Sisters callous: one Sister is aware of a soldier’s moldering arm pain – “I know, but I can’t do anything about it. He must stick it out.” She is frustrated at how little she can help her patients, but finds repetitive tasks (such as laying cutlery on the trays) meditative and helpful to sort out her thoughts.

Being in the Officers’ ward at first, Bagnold wonders how life will turn out for some of these men whose injuries have been life-changing: The soldiers “living so near the edge of death, they are more aware of life than we are…Will they keep this vision, letting it play on life? Or will it fade?”

Having been raised in a wealthy environment, she is bemused by the sisters she has to work with and is not in awe of any ranking system there was. Speaking of how the Sisters viewed the world, she is damning and cutting.

“Their conception of a white female mind is the silliest, most mulish, incurious, unresponsive, condemning kind of an idea that a human creature could set before it.”

She sees the Sisters pandering to the important and wealthy visitors to the detriment of the patients and can’t understand it. However, she is fully aware of this attitude of hers and knows that it will get her into trouble at some point. But still – she persists. Why? Is it because of her removed point of view that she feels that she doesn’t have to play the game? Is it because she is wealthy and thus has no impetus to not make waves with the risk of losing her job?…

Some other interesting points that came up whilst reading this:

  • Patients and nurses/docs could smoke all day and night in the wards (in their beds if required)
  • The ward’s windows were perpetually open even on cold snowy or foggy nights so people inside the building could see their breath whenever it was cold (inside or outside)
  • Limited medicine meant that patients would honestly never know whether they would get better or not and how to comfort someone in that situation

Overall, a good read about a very hard experience. Bagnold writes in an ethereal, dreamy way, floating from one thought to another with no dates or times or days to anchor the story. This creates a foggy experience for the reader (which is echoed in the foggy weather they have during the winter) and an experience which is not clear but more felt than anything.

Must give credit to Booksnob for steering me to this book. Thanks!

The Great Starvation Experiment – Todd Tucker (2006)

I am not too sure where I came upon this title, but thought it looked interesting so ended up doing an ILL. (What a great program!) This book covered a little known but true experiment done towards the end of World War II in the US, where researchers wanted to learn how to help people who had endured serious famine and starvation recover. However, where to get the human subjects?

With war comes Conscientious Objectors (COs) and so a number of them (all men, of course) signed up and went through a selection process for the year-long project. They would be systematically (and voluntarily) starved for a period of time to enable scientists to find out how best to help famine victims recover.

The Principal Investigate (PI) was Dr. Ancel Keys – he who invented the K Ration for military personnel (that later became Meals Ready to Eat/MREs).  (Keys was also going to be responsible later on for linking cholesterol with heart disease.)

Funded by the U.S. Army and located in the basement of the University of Minnesota football stadium, 36 men were chosen and invited to make their new home in the dormitory set up. There, they would have to face a nearly constant battery of medical tests (along with psychological tests as well), and fulfill the expectation of walking at least 22 miles/week – all on the honor system of not eating off the official diet. (They could walk into town where there were restaurants etc. so the temptation was there.)

Such an experiment would not be allowed now as medical ethics have evolved, but back then, it was OK. The US knew that WWII would lead to widespread famine post-war, there was a group of healthy young men (all COs) who were willing to sign up for their country and their idealism, and there was available funding.

This was really quite a fascinating story (especially during the actual starvation stage). The subjects could eat during the starvation phase of the project, but it was extremely-controlled calorie-wise and menu-wise. The average man lost 25% of his beginning body weight and the photos documenting this weight loss are dramatic. (Life magazine did a special article on the experiment towards the end when the men had lost most of their weight.)

It was also intriguing to see how the lack of fuel affected the men, both physically and mentally. One man was booted out of the experiment for cheating and eating extra food (found out as he wasn’t losing weight at the same rate as the others).  Everyone else stayed the course, although not without event. Other results also noted included hearing being more acute during starvation (perhaps from the need to hunt for food?), and intellect not being adversely affected (although the subjects reported that they felt less smart when they were hungry).

As for the end results of the project, researchers learned how to effectively help famine victims recover. Previous knowledge was that the best way to re-introduce food to a starving person was through a stomach tube. Keys’ study showed that it was important just to give them calories, not a special complicated mix of proteins, carbs and fats. Food was what they needed. (This project also helped with treatment of those with eating disorders, as those have a very similar effect on the human body as this experiment did.)

So – interesting topic. The writing? Well, at first, I wasn’t sure if I could stick with the book as the writing style was very “Dick and Jane go to class”. Very low level, but as the book progressed, I got really sucked into the story so either the writing style improved or the story was enough to carry it because it wasn’t so jarring towards the end. I am thinking that was an early project for Tucker who would, I hope, have a better grasp of writing by now.

Very interesting book about a fascinating topic. Recommended.

The L-Shaped Room – Lynne Reid Banks (1960)

This novel is by author Lynn Reid Banks about a young English woman (changed to French for some reason in the 1962 film) who ends up being unmarried and pregnant (the shock! The horror!), gets kicked out of her home by her father and lives in a dreary boarding house in London.

I am not exactly certain how I came across the title (apart from that it is somewhat of a domestic classic in some circles), but I do think that when it came out at the time (early 1960’s), it must have caused a sharp intake of breath for a lot of people through its coverage of taboo subjects such as unmarried sex, abortion, prostitution, and other topics probably only whispered about that time in certain circles. It also doesn’t really gloss over the harsh realities of poverty and living in insect-invaded housing with shared bathrooms and not much heat.

To my twenty-first century eyes, this story was not all that shocking because this sort of thing happens all the time now. However, what I did find noteworthy was how little things have changed in some ways: there are still some families where the girl would get kicked out for being pregnant and unmarried, and there are still not a lot of choices for some women in that situation (although at least health care has evolved where women don’t have to go to back alleys any more).

At the same time as reading this book, I am also reading “Consequences” by E. M. Delafield (who wrote Provincial Diaries  et al.). This is set in 1899 (but written in 1919), and also features a young head-strong female protagonist facing a similar situation: not pregnant, but she is in her third year of being a deb and still no appropriate suitor. What to do.. what to do… as we all know how precarious an existence can be when you are an aging spinster in those late Victorian days… Where would you live when your parents died? How would you pay your bills if you didn’t have a husband and didn’t work (apart from doing some piece-meal sewing work etc.)?  So, even though “The L-Shaped Room” is actually more than half a century on from the Delafield volume, some things had not changed that much (despite the forward movement of the women’s movement). The forward steps were that now it was acceptable for women to work and be more independent, but still there remained obstacles: financial, the societal shame of being an unmarried mother, poverty etc.

So – “The L-Shaped Room” was quite a good read, and I can imagine how shocking it must have been when it was first published. I have the sequel to it in the TBR pile and will probably move that closer to the top. It’s well written with a forward-moving plot – you can tell Reid Banks had been involved in playwriting as the dialogue was strong and the characters pretty well developed. However, true to its time, it is quite awful in how it uses discriminatory language towards people of color (one of the neighbors is a person of African descent) and Jewish people, and how the characters do not shy away from employing narrow stereotypes. However, when you place the book in its time, this all seems to fit, but it was still harsh to read about such language and attitudes being ok.

(Coming from a public health background, it was also interesting to see how lax people were about  prenatal care – lots of drinking, smoking, poor nutrition etc…) At least that has changed for the better over time for the most part for first world citizens.

A good read overall, and one more off the TBR mountain.

Shadows of the Workhouse – Jennifer Worth (2005)

A former midwife writes of her time during the 1950’s in East London when she worked with a group of nuns helping the poorer families. Divided into three parts, the book looks at this time through the eyes of three very different people: brother and sister Frank and Peggy who were both raised in the workhouse, Sister Monica Joan (a not-so-good nun) and then old Mr. Collett’s heart-breaking story to end with.

Although the first two stories are powerful in their own rights, Mr. Collett’s story was the one that I found most poignant and memorable. The author, also a nurse as well as midwife, is assigned to help Mr. Collett with his slow-healing leg ulcers, and in doing so, the young nurse becomes friends with the old soldier. Through describing the conversations they both had, you get to know the old man – his life fighting in the Boer War and his family afterwards. Although his story is probably similar to lots of other elderly people (with respect to fighting in various wars etc.), it was sad to realize just how much importance he placed on the daily visits of his nurse and friend. How many other elderly people are out there in similar incredibly lonely situations like his?

Very poignant for me to think about, especially with all the holidays coming up.

Another over-arching theme throughout the book was the looming shadow cast by the workhouse and its reputation on the patients to whom the author was nursing. Workhouses officially closed in 1930 by Acts of Parliament, but they remained very similar but now called “institutions”. However, for many of the older population, the memory of the workhouse threat still hung over them and filled them with horror.

An interesting book about a forgotten (or at least neglected) part of history. I will be moving my other workhouse book up the TBR pile to get a different view point.

Radioactive: Marie and Pierre Curie, a Tale of Love and Fallout – Laurie Redniss (2011)

An intriguing mix of art and science, Radioactive is a fascinating biography of Marie Curie, who (along with husband Pierre) was famous for her work on radioactivity. Except this book is much more than a straightforward telling on Curie’s life (interesting though it was) – it also encompasses the history of the atomic and nuclear bombs, the invention of x-rays, women’s role in science, love, revenge and even a few duels.

Using a mix of sources and presenting these sources in a variety of ways (photocopies of actual documents, letters, interviews with weapons experts and survivors of bombs etc.), author Redniss leads us through the life of the Curies and how their research eventually led to horrible events like Hiroshima, Chernobyl and Three-Mile Island. But, as with most things, bad can be balanced with good and their research also led to x-rays (meaning more accurate surgery) and radiation (in the ongoing treatment of cancer) and more effective battlefield medical treatment (through the invention of portable x-ray machines).

Redniss used a artistic technique called cyanotype print which is a photographic image created in white on a blue background, which through a mix of sunlight and other chemicals, produces a ghostly, almost ethereal image. Redniss explains in the afterword that she wanted to use this process to reflect the nature of x-rays and it seems very appropriate as you read the book.

This was a really interesting reading experience for both the scientist and those of an artistic nature about a brilliant and complicated researcher who changed the world. If you want a straightforward reading experience, this volume is not for you. But if you’re willing to view Curie through an artistic lens and through several layers of time, then you will like this. I am not a scientist in any way, and in fact, know very little about a lot of it, but this info was presented in such a way that even I, the non-science person, found it really interesting. No small achievement, methinks.

(She was also awarded two Nobel Peace Prizes in different years for different fields of research. She was the first woman to become a professor at the Sorbonne. Since they knew little about safety concerns with radiation when they were researching, all the Curie’s papers from the 1890s are considered too dangerous to handle. (Even her cookbook is highly radioactive.) Documents are kept in a lead-line box and can only be handled by those wearing protective clothing.

2011 has been declared the Year of Marie Curie by both France and Poland.

The Ghost Map: The Story of London’s Most Terrifying Epidemic – and how it Changed Science, Cities, and the Modern World – Steven Johnson (2006)

A well-written and well-researched look at London’s cholera epidemic in 1834. London at that time was a growing city with no effective infrastructure for municipal services such as safe water or effective waste management. People would just collect their … waste… and either throw it down into the cellar where it stayed until things got unmanageable and the inhabitants called for the Night Soil Man to come and clean it out (which must rank up there in the World’s Most Disgusting Jobs of the Victorian Era).

And this custom of throwing the human waste out of the window into the nearest drain was exactly how the particular epidemic started. Cholera kills many and it kills fast, especially when the vast majority of health officers believe in the Miasma theory (or that the epidemic was caused by noxious smells which, of course, were everywhere then).

A medical doctor, Dr. John Snow, decided to try to work out how the cholera epidemic was spreading and why. There didn’t seem to be a pattern to the Miasma theory – if this was true, wouldn’t the people who work with the smelliest jobs be getting sick? Well, they weren’t so Snow knew there was something else to look for. However, he was going against the widely held belief of Miasma, so he knew that when he found the answer, it would be hard going to convince the Powers that Be.

Snow recognized that the cholera was being spread through water – every city area had its own water pump where neighbors would go for their daily supplies, and it was common knowledge that some pump water tasted better than others. The Broad Street pump was the one in focus in regards to the cholera epidemic, and although Snow convinced the Board of Health to remove the pump handle (thereby making it unusable), it was not enough to sell the theory of water-borne contamination.

At the same time, a young curate Charles Whitehead was doing his own detective work although Snow didn’t know that at the time. Whitehead had an intimate knowledge of the surrounding community, and by asking questions and tracking down affected families, he worked out that it also came from the Broad Street pump.

So, between Snow and Whitehead, the waterborne contamination theory was proven, but not without a big fight to convince the powerful London Board of Health (who had the power to change things). By disease mapping in various ways (i.e. drawing a map which reflected which houses where were affected by the epidemic from a birds-eye view), the board cut off the water supply to that particular pump, but it was a couple of years before they were fully convinced by the waterborne theory.

What is particularly notable about this case is that this marked the very first time that a public institution (i.e. the Board of Health) had made an informed decision based on scientific theory. Before everything had been based on the Mediaeval miasma theory (which was never proven using the scientific method). So, in effect, this cholera epidemic changed the whole future for urban environments – it lead to the formation of a new effective and safe sewer system for the city, it lead to the formation of the study of epidemiology, it introduced the concept of public health…

Overall, I really enjoyed this book as it is in a field that I particularly love – public health. Unfortunately, public health funding in the US tends to move like a pendulum in that it either receives tons of public funding so disease goes down which leads people to believe that there is no need for public health which leads to disease going up which means the funding returns because there is a problem.

My city is having a public hearing this afternoon on whether to close its own City Health Department which seems to me to be a *very* short-sighted thing to do. When a problem (such as STDs, vaccination etc.) is everyone’s problem, it’s no one’s problem and so nothing usually gets done. Public health needs to have a leader, a headquarters, and the City Health department provides that. It’s unbiased, it covers most of the bases, and it’s just the right thing to do. Fingers crossed that they don’t close the department, but
I wouldn’t be surprised if they do, as that’s where the funding pendulum seems to be right now.

Update (edited 08/22/11): The City Council will be reviewing the decision to shut City Health over the next 90 days. However, most of the employees will be RIF’d at the end of the month, so not sure how this will change things. We will see.

Public health will be re-funded at some point in the future, but only when a big community health problem raises its head.

Back to the book (and off my Public Health Soapbox): this was a good read with a very nice bibliography at the end of it for further reading.

This was an Inter-Library Loan. Hooray for Texas libraries.

Monique and the Mango Rains – Kris Holloway (2007)

This was a good fast read for me. It is a memoir detailing the friendship that develops between a young idealistic Peace Corps volunteer and a village midwife in Mali (a country in West Africa), a place where childbirth had a high mortality rate.

What I thought really made this strong was that the author (the Peace Corp volunteer) has written it in a sensitive way so that Monique comes across as the expert (which she is) instead of the incoming Peace Corps volunteer being the Great White Colonial Person here to save the day.  Obviously, both people have a lot to learn from each other, but I really appreciated the tenderness that the author feels for her friends in the African village.

The story takes place over the two years that Kris Holloway and boyfriend John spent as volunteers with the Peace Corps in a smallish village that is miles out in the African bush, and as I read the descriptions of where they lived and what they ate and their day-to-day encounters, it was clear that you would have to be a special kind of person to live in that environment. (I am not one of them. I like all the modern conveniences, I am afraid. Plus I am bit picky about food. <Massive understatement there.>)

Monique is a specially trained health worker and midwife, so she is vital in the health and care of the village children and their mothers. By  holding regular clinic hours and weighing babies on a regular schedule, Monique is able to ensure that any health problems that turn up could easily be handled by her (very basic health care) or shipped to the larger town nearby for further treatment.

As a big public health believer, I was impressed that the villagers embraced the health clinic on the whole, with the mothers and their young families coming for shots or medicine or whatever they may have been needing. It wasn’t a big operation by any means, and probably did not require a lot of investment to start (or keep it going), which meant that it was replicable in other villages. Presumably, there were other “Moniques” in Mali doing something very similar to her clinic.

Monique was notable, as well, for fighting for her beliefs, despite the traditional cultural expectations which could have quite easily squashed everything she wanted, both for herself but mostly for the other women in the village: education for girls and boys, effective birth control, safe water… It cannot have been easy for Monique to buck the trends in this small insular world.

What was most interesting to me was the friendship between the two women. Their backgrounds were very different, there were language difficulties, cultural differences, and yet throughout the assignment, they became good friends, so much so that when they finished their assignment, both Kris and John invite Monique to visit them in the US the following year. Helping Monique to plan her travel, the author handled Monique’s lack of experience in long-distance traveling in a respectful way – still pretty funny in places, but in a respectful tone which I loved.

There were good descriptions of life in the village and how the events turned on a seasonal calendar: the rainy season, the unexpected “Mango Rains”, the passing of human milestones (death, for example). Since it’s highly unlikely that I will ever get to a small village in Mali, this gave me the feeling that I at least had experienced vicariously.

Bought from Amazon.