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Book Review   |    
Psychiatric Services 2010; doi: 10.1176/appi.ps.61.8.847

From the book review editor: The publication of first-person accounts has grown exponentially in recent years, including those by physicians, patients, former patients, and family members. There is a long, rich history of such accounts in psychiatry (1,2), but lately these accounts are published more frequently than ever before. Personal accounts are now a genre of such a magnitude that the University of Massachusetts Medical School's librarian Jeffrey E. Long published an annotated bibliography of remembered childhoods that is just under 500 pages (3). This month we present brief reviews of 25 first-person accounts published between 2007 and 2009.

• If the word "tweak" has any connotation for the occasional or sporadic use of drugs, Nic Sheff's Tweak: Growing Up on Methamphetamines (New York, Atheneum, 2007) is mistitled. As for "growing up," that's not correct, either, and there are plenty of drugs consumed that aren't methamphetamines. A better title might be Heavy Use: 642 Days in a Young Life of Polysubstance Dependence. If such an autobiographical account might interest you, dig in. I found the book very readable, although it left me feeling really dirty. The author makes many friends, if you can call them that, and describes different relationships and interactions, from heavy deals to sweaty sex, mostly around using or not using drugs, including some episodes with professionals described as psychiatrists, who seem less concerned with boundaries than I am. Sheff frequently partners with girls just as into it as he is, and they inhabit many scenic locations, most of them in California. His persistent ability to victimize others is impressive, and educational. Why this book was marketed for young readers is a little disturbing. The experience of reading it left me hungry to read first-person accounts by psychiatrists or other mental health professionals—people like us, at the other end of the phone.—Chuck Joy, M.D., private practice, Erie, Pennsylvania

Beautiful Boy (Boston, Houghton Mifflin Co., 2008) is the brilliantly written and profoundly moving account of the descent into methamphetamine, heroin, and alcohol addiction of Nic Sheff, author David Sheff's only child from his first marriage. Yes, Nic was a sensitive child, and his parents divorced acrimoniously when he was four. And yes, he was shuttled back and forth, often alone, between his father's home in the Bay area and his mother's home in Los Angeles. But so are many other children, and they do not all end up as meth addicts—so why did Nic? The answer this rich, personal, and tender book arrives at is that there was a hole in Nic's soul and the drugs gave him a wonderful feeling that he did not get growing up. The drugs also immunized him, albeit briefly and at a terrible price, from fear. Nic loved this transiently real, ideal state, and if the 20th and 21st centuries have taught us anything, it is that people are willing to both kill and be killed for certain ideals. Recovery for Nic is a life-and-death struggle and a lifelong process. Ultimately, Nic and his parents come together for very meaningful family therapy. After a prolonged and exclusive focus on the 12-Step approach to addiction, a more psychoanalytically informed approach becomes particularly valuable to David, reminding us that a variety of treatments should be considered in working with addicts and their families. It is often said that in psychotherapy, patients make us feel like they do. To the degree that this is true, we get a vivid picture, through David's anguish and chronic sorrow (a wound that never fully heals) of how terrible Nic must have felt growing up, despite his parents' and stepparents' best efforts. David Sheff's wonderful articulation of his and his son's remarkable journey is better than a textbook and informs us about the economic, intrapsychic, interpersonal, familial, and sociologic burdens caused by addictions.—Baer Max Ackerman, M.D., Alma Associates, Plano, Texas

My Brother's Madness (Willimantic, Connecticut, Curbstone Press, 2007) emerges as a triumph in behavioral science literature, contributing both to understanding the plight of patients and families living with mental illness and to advocating for access to treatment and reduction of stigma. Written by practicing psychotherapist Paul Pines, M.S.W., the memoir is a deeply personal, boldly honest, and gripping story of the effect of mental illness on the lives of two brothers. While one brother suffered with paranoid schizophrenia, diagnosed after he quit medical school, the other endured as an advocate for his brother's health and well-being. The theme of separation within a parallel existence permeates the prose like destinies traversing a universe, with departures and mergers often accompanied by moments of shocking revelation. The account includes italicized, diary-like entries that provide an account of a brother's developing mental illness and standard, nonitalicized text that outlines the progression from the brothers' childhoods; the two narratives merge at the point of the affected brother's voluntary hospitalization. Peppered throughout the book are engaging anecdotes that range from heartfelt to irrepressibly disturbing. I thoroughly enjoyed the book, and it was nearly impossible to put down, especially as it neared the end. Set largely in the 1970s and 1980s, dynamics of the psychiatrist-patient relationship and insights into the side effects of psychotropic medications are explored from a family member's perspective. However, this bears no resemblance to an "antipsychiatry" point of view. To the contrary, the true life stories of Paul and Claude speak to their efforts to positively affect the lives of families struggling with psychiatric disorders.—Jared T. Ritter, M.D., University of Hawaii, Honolulu

• Journalist Karl Taro Greenfeld is the older of two sons of a Jewish father and Japanese mother who did not want children. His brother, Noah, is autistic and the subject of Boy Alone (New York, Harper Collins, 2009) and, perhaps ironically, the one to whom the book is dedicated. In Greenfeld's view, Noah is the central force of the family: "Noah gives purpose to our family, eliminates choices, forces us down narrow paths. Noah is a dream killer, reducing our family's idea of a better life to one banal state: normality." How, then, could there not be resentment? But Greenfeld never deals with this directly, and the book feels vaguely disingenuous. When Greenfeld switches from fact to fiction without informing the reader, I was not mollified by his after-the-fact explanation that this is his fantasy. Author's resentment, perhaps? As the two boys get older, Greenfeld notes a pattern to their lives: "My own days are lived around Noah. … What I give, I believe, I have given because I have no choice." Greenfeld recounts and makes observations, but his feelings are consistently cut short. Resentment? The author's profound but never fully explicated ambivalence leaves the reader with a book that is less a coherent tome about the author's confusions than simply a confusing book. Instead, for a powerful and professionally useful portrayal of autism within the family, check out Clara Claiborne Park's two books about her daughter (and the rest of the family), The Siege and Exiting Nirvana.—Jeffrey L. Geller, M.D., M.P.H., University of Massachusetts Medical School, Worcester

The Night of the Gun (New York, Simon and Schuster, Inc., 2008) is half investigative reporting, half Step 10 of Alcoholics Anonymous ("Continued to take personal inventory and when we were wrong promptly admitted it"). David Carr sums up his story by page 27—addict, criminal, abuser and exploiter of women, accidental father of twins, talented writer, with great friends and family. One paragraph provides the "hook" to keep reading: "To be an addict is to be something of a cognitive acrobat. You spread versions of yourself around, giving each person the truth he or she needs—you need, actually—to keep them at one remove. How, then, to reassemble that montage of deceit into a truthful past?" That is the question that David Carr answers in 60 brief stories. They retrace the lost path of his heavily drug-influenced life through videotaped interviews with those he used with, loved, beat up, impregnated, exploited, and parented and through addictions, legal problems, marriage, cancer, losses, 9/11, Katrina, and professional victories. He squints his way through the cocaine, heroin, and alcohol fog of his past in discussions with friends, sponsors, attorneys, ex-lovers, employers, coworkers, and daughters. This book is a genuine look at addiction from the inside out, fabulously (sometimes hilariously) written by a talented reporter, investigating his own history. While mental health and addictions workers will appreciate the nuances, the book has much wider appeal; my engineer-husband and my college-age kids loved it.—Maggie Bennington-Davis, M.D., Cascadia Behavioral Healthcare, Portland, Oregon

• On September 30, 1969, 16-year-old Steve McKee witnessed his 51-year-old father die of a heart attack. In his 2008 memoir, My Father's Heart: A Son's Journey (Cambridge, Massachusetts, Da Capo Press, 2008), McKee searches for the meaning of this event. Like many, McKee grapples with competing explanations of a loved one's illness. At times, he blamed his father's chain-smoking and workaholic lifestyle; at others, his genes. Yet in researching the life of his father, who was the son of a working-class Irish Catholic family from Buffalo and provided a middle-class lifestyle for his own family, McKee also found that his father's personal sacrifices were common among his generation and perhaps even heroic (he was a "martyr" to postwar industriousness). Determined to avoid the same fate of his father, McKee rigorously exercised and dieted for many years, only to learn in 2005 that he, too, has cardiovascular disease. He is his father's son, after all, and this book is McKee's attempt to understand what that means. Readers who enjoy this book might consider recommending it to patients who have cardiovascular disease or who have loved ones who do. Considering the frequency at which cardiovascular disease is comorbid with mental illness, psychiatric professionals may be recommending this book quite often.—Vikram Kambampati, M.D., Federal Medical Center Devens, Ayer, Massachusetts

• In Manic: A Memoir (New York, HarperCollins, 2008), Terri Cheney writes about her lifelong struggle with bipolar disorder—the highs, the lows, and everything in between. A successful entertainment attorney, the author did everything possible to hide her condition, which repeatedly threatened her career and her relationships. Consistent with the presentation of individuals seen in community and inpatient mental health settings, Cheney recounts often becoming desperately suicidal from her depressive states and being self-destructive during the manic states. Through different medication trials, some successful but most of them not, Cheney yearned for stability so her illness could remain a secret. Unfortunately, as is true for so many people, bipolar disorder impaired Cheney's functioning to the point where she could no longer deceive herself or others. Each chapter provides a new example of the ravaging effects of bipolar disorder. Although the chapters do not flow smoothly from one to the next, in a way they reflect the chaotic and unpredictable nature of this illness. The symptoms of bipolar disorder are illustrated through this collection of anecdotes, making this book appropriate for mental health professionals and the average reader. Ultimately, this memoir will suck you in and allow you to relive the manic and depressive roller coaster that Terri Cheney calls life.—Hayley Porter, Psy.D., Springfield Hospital Center, Sykesville, Maryland

• In his book Hurry Down Sunshine: A Father's Story of Love and Madness (New York, Other Press, 2009), Michael Greenberg tells the story of his daughter's first psychotic break and his encounter with the New York inpatient mental health system. His explicit comments about that system and about mental health providers in general are unflattering. As the story of how his life has been changed by mental illness unfolds, we witness the many tragedies of mental illness: the shame, the cost, how it can strike in youth, and the long-term toll it can take on an individual and a family.—Annette Matthews, M.D., Oregon Health and Science University, Portland

• If the most valuable feature of a first-person account of illness is to present an experience with which others may identify and find relief from the isolation of chronic illness, then Always Looking Up: The Adventures of an Incurable Optimist (New York, Hyperion, 2009) succeeds. Yet author Michael J. Fox's celebrity status may distract some readers from this goal. Fox acknowledges that his public position grants him advantages in responding to hardship. Few will have Muhammad Ali, Lance Armstrong, and Robin Williams as their support group. But for me the glitz did not detract from the universal message, that responding to illness is about choices. Once one accepts that the choice to be well is gone, the rest is about what choices are available, and there are always choices. Most of the book is about Fox's choices and his genuine accomplishments in political and advocacy circles, outside of his entertainment career. All, including his substantial fan base, will appreciate hearing his impressive personal story. Others might like to hear more about his journey through diagnosis and acceptance. Even the most optimistic man on the planet must have darker times than he reveals.—Drew Bridges, M.D., The Storyteller's Bookstore, Wake Forest, North Carolina

• To sum it up succinctly, Bill is trying to get to someplace quiet. Not just a quiet street on a country road, but an internal space without noise, judgment, or fear. This is a tall order, but William Alexander is able to coalesce his Eastern spiritual practice with his 12-Step program in order to accept aging, and ultimately his fear of death, in Hi, I'm Bill and I'm Old: Reinventing My Sobriety for the Long Haul (Center City, Minnesota, Hazelden Publishing, 2008). There are multiple themes of self-discovery and Bill-tested suggestions for reinventing "a life of perpetual longing and endless dissatisfaction." Although anyone with chronic neurosis would welcome such advice, I would disagree with Mr. Alexander's assertion that this book is for everyone. Still, it is a lovely story and could serve as a solid source of support for Bill's many peers, including those who have been on the winning side of the addiction battle for many years and would like to give up fighting in general. The graceful manner in which he handles the challenge of aging is admirable and in no way defeatist. He offers up senior citizenship as another opportunity to live and reflect on one's life, rather than as an excuse to admit futility and go back to the bottle.—Jenya A. Kaufman, M.D., University of California, San Francisco

• Time: Time to mourn, time to accommodate, time to reflect, and time to mature. Dancing at the River's Edge: A Patient and Her Doctor Negotiate Life With Chronic Illness (Chicago, Independent Publishers Group, 2008) starts with a discussion of time and proceeds across two people's shared epoch. Alida Brill has a fiendishly unpredictable autoimmune disease, and her collaborator, Michael D. Lockshin, M.D., deftly helps her manage it without violating her autonomy. Dr. Lockshin respects his patient and is humbled by her vexing illness, and his respect and humility serve him well. They are tremendous gifts to Alida, who describes encounters with arrogant and dismissive physicians who were unable to find a human being amid her symptoms. Alida and Michael take turns writing chapters that recount their experiences as teammates who battle her form of Wegener's granulomatosis. Michael likes patients who engage and challenge him, and the book's alternating format fits his preference for dialectical exchanges. Alida smoothly describes what it's like to be chronically ill yet alive. Through victories and setbacks, the reader learns that if one gets a chronic disease, pick a human being who happens to be a doctor to help you. Otherwise, you'll visit every corner of hell, not just the ones that the disease takes you to. And sadly, you'll go alone.—Curtis Adams, M.D., University of Maryland, Baltimore

• Memoirs—especially such beautifully written ones as this one, which chronicles the lingering, generational aftermath of a young woman's brutal murder—are difficult to review. By their nature, they are meant to make the private public. The public in turn must experience the private as meaningful. Maggie Nelson's The Red Parts: A Memoir (New York, Free Press, 2007) doesn't fully succeed. Annie Dillard describes Nelson's book as "genre-defying"; another reviewer calls it "Didion-esque." Both statements are true. Joan Didion's voice echoes throughout, unfortunately too often. Instead of thinking about Nelson's narration of the events surrounding her Aunt Jane's murder, I found myself remembering Didion's The White Album. Mixing childhood memories of her father's death, too much information about her present life, the voice of a crime-beat journalist, frequent morose academic references, and scattered allusions to her book-length poem, Jane, Nelson attempts—I think—to capture the stages of grief flowing into one another, their currents merging and eddying within three generations of her family. But she moves too swiftly from anger to acceptance in the final pages, when the trial ends of a man newly linked through DNA to Jane's murder. Every page prior belies any such sudden resolution. And yet, as Nelson seems finally to find in those last pages her own voice of genuine mourning, perhaps the family's grief does recede.—Susan E. Bailey, M.D., Johns Hopkins Hospital, Baltimore

• In Chasing the High: A Firsthand Account of One Young Person's Experience With Substance Abuse (New York, Oxford University Press, 2008), Kyle Keegan and Howard B. Moss tell the poignant story of a young person's addiction and recovery. The book provides pearls of wisdom as Keegan spirals downward, hits rock bottom, then recovers, becoming a successful father and professional diver. Chasing the High exceeds its stated objective: a "useful, easy-to-understand resource on substance abuse, treatment, and recovery." Keegan transcends an adolescence where he "felt out of place" and recovers from heroin addiction by "developing a relationship with myself and figur[ing] out that the more my self-esteem grew and the more I learned to love myself, the less need I would have for the drugs I had used to mask my feelings, emotions, and even my identity." This growth occurs through numerous trials of detoxification and rehabilitation, a symbolic "trip from hell and back." Interspersed with the main author's story are facts and figures given by Moss, an addiction expert. The process of recovery is discussed in a way that provides encouragement to adolescents and young adults suffering from addiction. The basic premise of this book is that young people with addictions can and do recover and more importantly, that recovery is a lifelong process, not a single event, and will require multiple trials of treatment.—Cheryll Bowers-Stephens, M.D., M.B.A., Ochsner Medical Foundation, New Orleans

• It seems axiomatic to clinicians that most patients with eating disorders are female, so this small first-person account is a timely, at times painfully insistent reminder that men, too, can suffer from binge eating disorder. Alternating between accounts of the mountains of comforting food ingested by author Ron Saxen, then his strenuous and ultimately hopeless efforts to lose weight, The Good Eater: The True Story of One Man's Struggle With Binge Eating Disorder (Oakland, California, New Harbinger Publications, 2007) eventually details salvation through the intercession of a healing romantic relationship. Drifting through the excruciating and cloying menus of gastronomic excess is the narrative of "self adrift" then transformed into a seemingly solid sense of "self redeemed." "Wrong Ron" can become an only slightly better Ron by faithfully playing the role of the family's scripted "good eater," gorging himself with third and fourth helpings, only some of them covert. The book is haunted by the tragic leitmotif of his cruel father (shades of Conroy's Great Santini). At times the graphic descriptions of unbelievable amounts of food consumed seem almost to threaten the reader with binge eating disorder by proxy. More a description of the problem rather than an easily generalized solution, the book does, however, effectively portray the link between eating disorders and the cult of the body and its most merciless incarnation—in the career of professional modeling. In its explication of restoration of self, this cautionary book becomes more than just the story of a (mostly) successful resolution of a severe eating disorder.—Allan E. Crandell, M.D., Northern Navajo Medical Center, Shiprock, New Mexico

• I really enjoyed In the Blood: A Memoir of My Childhood (Jaffrey, New Hampshire, David R. Godine, 2007), a book about the boyhood of Britain's Poet Laureate Andrew Motion. Framed by the catastrophic loss of the author's mother in a riding accident, the book chronicles Motion's development up to that moment, alternating between his home life with his parents and boarding schools. I began the book finding it hard to believe that anyone could recall so many details from childhood and ended it finding that all sorts of my own memories were evoked by the vividness of the writing. The only time I read fiction is when I am asked to review books. The last novel I reviewed I gave away easily to a casual visitor: this one I will give to a family member or maybe a close schoolmate. This book isn't fiction, but it has all of fiction's imaginative qualities. What's the mental health angle? On the one hand this book is an attempt by Andrew Motion to heal the loss of his mother, but for me, reading it is participating in Jeffrey Geller's ongoing project to improve the mental health of his reviewers and readers of this journal by persuading them to read books of imagination.—Benjamin Crocker, M.D., community psychiatrist, Portland, Maine

Geller JL, Harris M: Women of the Asylum. New York, Anchor/Doubleday, 1995
 
Peterson D: A Mad People's History of Madness. Pittsburgh, Penn, University of Pittsburgh Press, 1982
 
Long JE: Remembered Childhoods. Westport, Conn, Libraries Unlimited, 2007
 
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References

For additional reviews of personal accounts, visit psychservices.psychiatryonline.org/content/vol61/issue8.

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References

Geller JL, Harris M: Women of the Asylum. New York, Anchor/Doubleday, 1995
 
Peterson D: A Mad People's History of Madness. Pittsburgh, Penn, University of Pittsburgh Press, 1982
 
Long JE: Remembered Childhoods. Westport, Conn, Libraries Unlimited, 2007
 
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