Review of Compulsive Acts, Elias Aboujaoude, 2008

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This book did not impress me much at all. A far more readable and useful books on obsessions and compulsions is David Adam’s “The Man Who Couldn’t Stop” which I regularly recommend to patients. I did some book reviews for Fortean Times from 2003 til around 2008, I think this is likely to have been one of the last – none seem to have a life online but will turn up in various archives I have.

Compulsive Acts: A psychiatrists tales of ritual and obsession

The best that can be said of Elias Aboujaoude’s Compulsive Acts is that it’s an easy read. Director of the Impusive Control Disorders Unit at Stanford University School of Medicine, one would hope that Aboujaoude would give both the general and specialist reader some great insight into the world of compulsion. He ranges from obsessive-compulsive disorders to pathological gambling and problematic internet use, yet never really rises above the level of a decent magazine article, in say Time or Newsweek.

In his introduction Aboujaoude makes much of the weighty ethical dilemma facing him putting pen to paper. Clearly the issue of confidentiality looms over every medical writers wishing to make use of the material presenting every day. However Aboujaoude’s throat-clearing and disquisitions on storytelling in his Mediterranean ancestry serve to annoy when it finally comes to the writing itself. In his fictionalised composites, Aboujaoude adopts an irritatingly breezy style, as well as betraying a tin ear for dialogue and a weakness for twee framing devices (in particular his receptionist Aurora, an attempt at down-to-earth wisdom) Furthermore, the cases seem to progress neatly to their conclusions (not necessarily happy or successful ones) and lack real drama. One feels that Aboujaoude must have a decent book inside him – if only it could be compelled to come out.

3/10 – Far from compulsive

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Piece on cardiac surgery in Times Literary Supplement

In the current TLS I have a review of two books on cardiac surgery. One is Stephen Westaby’s  memoir of his career, the other is Thomas Morris’ historical perspective.

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The full text is not freely available online, so here is the bit the TLS have made available to tease you all:

It is tempting to place Stephen Westaby’s Fragile Lives, a memoir of his career as a heart surgeon, in the category the journalist Rosamund Urwin recently called “scalpel lit”; following Atul Gawande’s Complications (2002) and Henry Marsh’s Do No Harm (2014) and Admissions (2017), here is another dispatch from a world arcane even for the majority of doctors. To some degree, Westaby’s book follows the Marsh template. In cardiac surgery as in neurosurgery, life and death are finely poised, and even minor technical mishaps by the surgeon, or brief delays in getting equipment to theatre, can have catastrophic consequences.

Like Marsh, Westaby, a consultant at the John Radcliffe hospital in Oxford, is jaundiced about the bureaucracy of health care and the mandatory “training” imposed on even the most experienced practitioners – “writing my personal development plan at the age of sixty-eight”. Now that death rates are published by the NHS,…

Makes you want to read the whole thing, does it not?

As it happens, Henry Marsh’s Admissions is reviewed in the same issue by George Berridge.

Review of “Casebook of Psychosomatic Medicine”, Bourgeois et al, IJPM 2011

The above review from the Irish Journal of Psychological Medicine follows on from my review of The Physician As Patient in the same journal. Both books were excellently written, and as time has gone by I appreciate their approach more deeply. As I say in the first paragraph, evidence based medicine and what could be called experience based medicine are often driven into a false dichotomy. Both these books possess wisdom in abundance, and wisdom based medicine is perhaps what we should all be aspiring to practice.  

Helen Pearson, “The Life Project”, Review in TLS 29/03/17

I have a review of Helen Pearson’s “The Life Project” on the UK birth cohort studies in the current TLS. The full article is behind a paywall so here is the preview:

Born to fail

To a non-Briton, the oft-repeated assertion that the NHS is “the envy of the world” can grate. If imitation is the sincerest form of envy, the world’s laggardly adoption of free-at-point-of-use health care is perhaps the truest mark of how much emotional investment the rest of the world really has in the UK’s health system. Early in The Life Project, her book on the British birth cohort studies, Helen Pearson describes them as “the envy of scientists all over the world”. In this case, envy is easier to precisely pinpoint; birth cohort studies have become all the epidemiological and social scientific rage in recent decades, especially around the turn of the millennium. My own daughter, born in 2008, is a member of the Economic and Social Research Institute’s “Growing Up in Ireland” birth cohort.

1946 is the Year Zero of birth cohorts. The low interwar birth rate had caused much…

 

 

A Spoonful of Medicine, Owen Gallagher

Published in 2004 in The Irish Catholic, my only publication there – the literary editor, Peter Costello, is the father of a friend. This is a somewhat sturdy review of an entertainingly straightforward little memoir. Perhaps this piece presaged more recent writings on medical memoirs.

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Owen Gallagher
A Spoonful of Medicine: Tales of an Irish Doctor
(Barny Books, Hough On the Hill, Grantham, Lincolshire, £5.99)
Reviewed by Seamus Sweeney

The public have a seemingly inexhaustible appetite for medicine, as can be seen in the TV schedules and the bookshops. There are two definite strains in medical drama. One is the hard-nosed likes of ER, or Samuel Shem’s House of God. These revel in the gory, the seamy, the adrenaline-fuelled, the sleep-deprived and the dramatic. The other sorts, as exemplified by The Royal, are exercises in gentle nostalgia and anecdote. A Spoonful of Medicine, Dr Owen Gallagher’s memoir of his time as a junior doctor, tends more towards the latter school, although it avoids sentimentality and cheap nostalgia.

This book is a collection of stories from Dr Gallagher’s years as a recent medical graduate in the late 60s and early 70s, particularly in accident and emergency, in paediatrics and in psychiatry.
Some anecdotes bear the hallmarks of much polishing over the years, and certainly some of the dialogue is rather unbelievable, with the characters coming out with perfectly grammatical paragraphs and overly pat witty repartee. There are several lapses on the part of the sub-editors, which lead to distracting typos and occasional confusion as to what precisely is happening on occasion.

However, these seem rather churlish caveats about what is a warm-hearted, entertaining book. The stories, while comic and sharply observed, are never cruel and Gallagher’s compassion comes through without ever becoming sanctimonious. Particularly in the final series of stories from his time in psychiatry, we sense his admiration and respect for certain of his patients’ bravery and approach to life.

It was a far different Ireland then, and it was also a far different medical practice. Certainly its impossible to conceive a character like Dr Moore, protagonist of one of the most memorable sections, being produced by today’s medical schools. Dr Moore was a GP whose practice revolved around the schedules of the racetrack rather than any notion of patient convenience. Moore had honed his system until the least possible amount of time was spent with the patients, with anything at all worrying referred to accident and emergency post haste. Dr Gallagher, working in the nearby A&E, bore the brunt of this extra work.

One patient recalled Moore completely ignoring his complaints, preferring to listen to the radio broadcast of a horse race, and then telling him to get himself down to the pub for a couple of pints and a few cigarettes, as “your complaint is mainly in your head, anyway.” Moore never asked a patient to undress, and would listen with his stethoscope over even the heaviest clothing. It may come as no surprise that his patients were all very fond of Dr Moore, who never kept case notes as he knew all the patients from living in the same community as them. Dr. Gallagher too came to appreciate his more endearing qualities.

It certainly is a long way from that to the obsession with targets and mission statements that marks modern health services. This book is not a sociological tract and it would be unfair to expect a deep analysis of the relative pros and cons of the health system, or indeed society as a whole, then and now. There is however a sense of loss at the passing of a certain pace of life and a certain approach to social interaction. Modern practice seems much more rushed and impersonal.

The book could also have been subtitled “what they don’t teach you in medical school.” If the book has a “moral”, it is that much of the education in human nature that makes a good doctor takes place far from the lecture hall or library. It is an enjoyable account of how one doctor acquired that education.

Review of The Physician As Patient, Myers & Gabbard, Irish Journal of Psychological Medicine 2008

The html version of this isn’t available, so rather unusually here is an image of my review of this book.  I have had reason to return  to this topic  of late.

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“a wry, gentle masterpiece” My review of “A Smell of Burning” by Colin Grant in current issue TLS

Having alluded to this beforehere it is

 

Dreamy states and forced thinking

Subtitled The story of epilepsy, Colin Grant’s A Smell of Burning is, most vividly, the story of Grant’s younger brother Christopher, who died in 2010 aged thirty-nine, during a seizure – a Sudden Unexplained Death in Epilepsy, or SUDEP. Christopher was the dedicatee of Bageye at the Wheel (2012), Grant’s memoir of a 1970s childhood in Luton dominated – until his mother showed him the door – by his father, the perpetually choleric, feckless Bageye. “In Memory of Christopher Grant (Baby G) – A wry, gentle, amused and thoroughly splendid fellow” reads the dedication, and A Smell of Burning captures the adult life of Baby G adroitly.

Bageye has a cameo in A Smell of Burning, thirty years later, anxiously asking Grant “How Christopher? I hear him have head trouble”. As Grant writes,

my father was a Jamaican born in 1928. His ­perception of epilepsy would have been shaped and governed by superstition that runs like water through the island. People marked with head trouble were all the more scary because until they did something that revealed their condition it was impossible to tell them apart from anyone else.

This fearful regard of epilepsy was not ­confined to Jamaica. On one levelA Smell of Burning is an account of (partial) progress, with fear and ostracization gradually giving way to a greater level of understanding, both neurological and social. These approaches have an uneasy relationship: “often the patient is lost in these early accounts of the growth of neurology; the focus is on medical advancement, and the patient is the means to it: his body provides the pathway to enlightenment”.

Enlightenment about epilepsy existed, at times, in the pre-Enlightenment world; Herodotus, in discussing the illness of Cambyses II, distanced himself from the notion of a “sacred disease”; the Hippocratic text On the Sacred Disease is an attack on the very notion of epilepsy as a deity-induced illness. And for all the advancement that has been made, epilepsy retains much of its mystery: considering the visionary, logorrhoeic experiences of Philip K. Dick, Grant writes that “all too often it has been assumed that psychiatry offers the best model to describe some of the behaviours and personality changes in temporal lobe epilepsy, but maybe these behaviours have only the appearance of similarity, and something altogether different is going on in the brain”.

The book is something of a hybrid; the disease memoir crossed with a more detached journalistic account of the history of a particular condition in history. Careful to point out the pitfalls of retrospective diagnosis, Grant weaves his brother’s story together with those of Fyodor Dostoevsky, Harriet Tubman, Vincent Van Gogh, Julius Caesar and a much wider cast of anonymous epileptics. We also read of the medical mavericks, megalomaniacs and pioneers (many of whom merited all three descriptors), whose insights merged eerily with the literary; “the language of Dostoevsky and Hughlings Jackson was uncannily similar. Both men were able to conjure for readers the spooky ‘dreamy states’ and ‘forced thinking’ of epilepsy”.

Some of the richness of the book comes from a sense of holding back. The same restraint was already evident in Bageye at the Wheel, whose somewhat wry, amused take on Bageye’s misdeeds carried a depth of emotion all the more powerful for forgoing the template of the misery memoir. Grant, who studied medicine for five years at the Royal London Hospital, presents us with a superb memoir of medical student life in the mid-1980s. In asides to the main story, he evokes the blend of detachment, disorientation, reverent fear of the consultant and a sense of practical uselessness which characterizes much of medical student life.

When, shortly after a seizure, Christopher insists on driving, Grant experiences a feeling chillingly familiar to many who care for those who, in one way or another, lose control – “a sudden sickening fairground ride of emotion – a shearing-away of certainty”. Later, he is asked one of the most arresting questions a carer of someone with epilepsy can consider: would you wish to experience what they experience? There is a veil of unknowing over what happens to the person, a veil they themselves cannot penetrate after the event. Christopher

with age seemed to grow more accepting, as if he had reached some accommodation with the seizures. At times he woke after a seizure with a look of such disappointment; and I imagined him at the end of a dialogue with the fits urging them not to go just yet, like Horatio commanding the ghost of King Hamlet, “Stay, illusion!”

The visionary seizures experienced by Harriet Tubman after a head trauma helped inspire the Underground Railroad, and while not personally religious, Grant is open to ­considering the heightened religiosity seen in some epileptic presentations as being on the credit side of the ledger.

Like so many with a chronic condition, Christopher kicked against being defined by epilepsy and its treatment.

“If he would just tek the medicine. Why the boy can’t tek the medicine, God for tell”, was a constant refrain of my mother’s. When questioned about his non-compliance Christopher would counter that the drugs didn’t work. Or that they dulled him and left him thick-headed. Other sufferers have spoken about how they have felt trapped in this way by the condition.

Colin Grant’s exploration of the literary, political, medical and scientific history of epilepsy is hugely compelling; his telling of the story of two brothers transcends the book’s twin genres and leaves us with a wry, gentle masterpiece.