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Book Reviews: A Sampling of First-Person Accounts   |    
Twilight: Losing Sight, Gaining Insight ? Malignant Sadness: The Anatomy of Depression ? Girl Singer: An Autobiography ? Crossing: A Memoir ? Not Guilty by Reason of Insanity: One Man's Recovery ? Stick Figure: A Diary of My Former Self ? Group: Six People in Search of a Life
Jeffrey L. Geller, M.D., M.P.H.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.11.1540-a
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by Henry Grunwald; New York, Alfred A. Knopf, 1999, 130 pages, $20 • by Lewis Wolpert; New York, Free Press, 1999, 196 pages, $24 • by Rosemary Clooney with Joan Barthel; New York, Doubleday, 1999, 336 pages, $24.95 • by Deirdre McCloskey; Chicago, University of Chicago Press, 1999, 266 pages, $25 • by Randy Starr; Tinley Park, Illinois, Recovery Press, 2000, 150 pages, $12.95 softcover • by Lori Gottlieb; New York, Simon & Schuster, 2000, 220 pages, $22 • by Paul Solotaroff; New York, Berkley Publishing Group, 2000, 339 pages, $13 softcover

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Reviews of seven books are presented in this sampling, covering a wide range of topics, including blindness, depression, substance abuse, transsexualism, comorbid mental illness and substance abuse, anorexia nervosa, and group psychotherapy.

In Twilight: Losing Sight, Gaining Insight, Henry Grunwald, formerly editor in chief of Time, Inc., and a U.S. ambassador to Austria, offers an autobiographical account of his progressive loss of vision to macular degeneration. He discusses the disorder itself in great detail, and he describes the challenges it has presented for him and those he spends time with. "One of the difficulties about macular degeneration," he says, "is that those around you can never be sure what you see, and you yourself are not sure, either." In many instances, Grunwald describes the need to see not only with the eyes, but also with the imagination and with memory, two resources he is able to draw on quite well.

Grunwald also describes his personal struggles with and reactions to his deteriorating vision. "A paragraph read," he says, "was a triumph; a sentence undeciphered was a blow." He is particularly pained by his inability to read and to write, two activities that were central to his professional and personal life. "Books are everywhere in our apartment," he writes. "As I look at the book-filled walls, they seem to give off a stubborn silence. The books mock me or thrust me into nostalgia." Grunwald indicates that although he has had to learn patience, he has also had to "be permanently ready to fight back against depression."

Despite the personal insights provided in Twilight, much of the book describes the history of and contemporary knowledge about macular degeneration. Grunwald draws heavily on the work of the researchers he cites in his acknowledgments. The book well portrays the intellectual sufferer's fascination with and drive to understand the source of his affliction.

Twilight is basically an essay presented in book form. In order to truly appreciate the book, one must be knowledgeable about art, the great books, and the New York City scene. Although Twilight provides less insight than it does facts about losing one's sight, it is a quick read, and worth the effort.

Lewis Wolpert, a professor of biology as applied to medicine at the University College in London, has written a strange book in Malignant Sadness: The Anatomy of Depression. While parts of it are a first-person account, much of the book attempts to provide factual information about depression and its treatments. Wolpert appears, like Grunwald, to have become fascinated with the disorder that plagues him. Unfortunately, in Malignant Sadness one is left with a book that is neither a satisfactory first-person account, nor an entirely satisfactory treatise on affective disorders.

The best part of the first-person account is contained in the introduction. Here Wolpert provides a better sense of what depression felt like to him than he does anywhere else in the book. "I was in a state that bears no resemblance to anything I had experienced before," he says. This state of being is elaborated throughout the book, but in sentences or paragraphs found amid factual material on affective disorders.

A major problem with the book is that the level of information it provides is very uneven. Wolpert sometimes makes highly simplistic statements, as though he were addressing an audience whose reading level is low. At other times, his narrative wanders into much more sophisticated scientific information. It is unclear who the target audience is.

Much of the book reports information from a series of unreferenced secondary sources. Wolpert frequently uses the expression, "one study says…." For anyone interested in outcome studies, this manner of presenting data is highly unsatisfactory. In many passages, however, he just seems to be stringing together information about depression. Single paragraphs are thrown in that are unrelated to the material that precedes or follows it. Among such paragraphs are one on sexual functioning and another on the effects of antidepressants on children.

Malignant Sadness also has more than its share of misinformation, such as in a discussion of electroconvulsive therapy, in characterizations of psychotherapy for depressed patients, in descriptions of attributes of psychoanalysts, and in a description of the sequencing of treatments for depression.

For Wolpert, writing Malignant Sadness was, he says, "a personal quest to try and understand the nature of depression, and how it can be treated and prevented." Although he may well have succeeded in his quest for himself, it is not clear who else might benefit from the book.

I picked up Rosemary Clooney's Girl Singer because I was interested in how it would cover Clooney's substance abuse and psychiatric hospitalizations. Girl Singer does briefly describe Clooney's drug use, with rare passages such as this one: "Because drugs had taken over… it no longer occurred to me to ask whether I needed them to sleep. The question was no longer relevant. I didn't ask it when I went into the bathroom at somebody's house, opened the medicine cabinet and just scooped up whatever I found. All I asked was my first question to myself in the morning: How many pills have I got? How's my stash?… I loved seeing the colors of the pills, like a bouquet in the palm of my hand: Percodan, Seconal, Miltown, Tuinal, sunshine and lipstick and snowdrifts."

Clooney informs the reader that her psychiatric diagnosis on admission to a psychiatric hospital was "drug-induced psychosis." Her coverage of her inpatient psychiatric treatment runs only two pages. Girl Singer is mostly a who's who of Hollywood during the Clooney era.

Those interested in Rosemary Clooney's substance abuse and psychiatric hospitalization would do better to turn to her earlier autobiography, This for Remembrance (1). There Clooney describes in greater detail the experiences of a psychiatric patient in the 1960s. In fact, the earlier book is the verbatim source for the few paragraphs that are contained in Girl Singer about Clooney's psychiatric diagnosis and treatment.

Donald McCloskey was a 52-year-old economics and history professor at the University of Iowa who, through a series of extensive and expensive operations over a three-year period, became Deirdre McCloskey, still an economics and history teacher at the University of Iowa, but now a woman. McCloskey's transformation was the answer to her dreams—which, at that point, were 40 or so years old. Although the transsexual procedure cost her her immediate family—Donald McCloskey had a wife, a son, and a daughter—it did not cost her her profession, and by her account, it vastly expanded her interpersonal relationships.

Donald himself had been doubtful about undergoing transsexual surgery. He believed himself to be "too big, too masculine," and wished that he had been "shorter, of slighter build and prettier face."

Donald faced yet other obstacles. He was a life-long stutterer; he wondered whether he could learn a woman's gestures without having had the history of a little girl developing those gestures. There is, throughout the book, an almost overwhelming attention to "passing." Deirdre asks herself again and again what more does she need to do to pass, and she catalogues, in great detail, episode after episode after episode of when she fails to pass.

Members of the McCloskey family beyond Donald McCloskey's immediate family were not terribly excited about his gender change. His sister, 11 years his senior, went to great efforts to interfere with his having surgery; she succeeded in having Donald involuntarily admitted to psychiatric units on the grounds—basically—that he must have been crazy for what he was trying to do. This part of McCloskey's life provides her with the opportunity to spend two chapters trashing psychiatry and to take pokes at psychiatry throughout the remainder of the book.

Crossing has many shortcomings. First, it is written in the third person, which distances the reader from the main character. The reader does not get a sense of Deirdre the person and never develops empathy for her. Second, the book is awash in stereotypes. McCloskey paints men and women as two distinct islands of traits with no gradations in between. She makes statements such as the following: "Woman's lives are collections of gifts; men's, of trophies." "She stopped paying attention to guy things—such as cars and sports and war stories." "Men, for example, are authorized to stare at women and make any proposals that come into their heads. …Since no woman, however beautiful, is permanently confident of her looks, the male gaze is often painful."

Third, McCloskey is guilty of not doing her homework—and her culpability is that much greater for her being an academic scholar. She refers to one or two previously published accounts by individuals who changed genders but ignores a significant literature of such accounts. She might have done well to take a look at Man Into Woman (2), a male-to-female transsexual account published in 1933; Being Different: The Autobiography of Jane Frye (3), published in 1974; and My Story (4), published in 1991. Such accounts, and many others, would have let McCloskey know what stories have already been told. Unfortunately, hers adds little to the literature.

Randy Starr's Not Guilty by Reason of Insanity is a folksy book written by a man who was found not guilty by reason of insanity of the crime of matricide. The book traces his life from its earliest stages to his recovery, a sequence that includes five years of psychiatric hospitalization.

Starr's travels through the system after he murdered his mother while in a period of active psychosis included the county jail, the Chester Mental Health Center in Chester, Illinois, the Illinois State Psychiatric Institute, and the Zeller Mental Health Center in Peoria. Starr was also the beneficiary of conditional release.

The book suffers from the fact that it was not actually written as a book, but rather is a compilation of many of Starr's shorter pieces. Thus the narrative has no real continuity or flow. The book is written in the style of "I'm just one of the guys"—Starr talks to his reader and uses conversational language, referring often to "stuff." Frequently, he asks his reader questions or requests that the reader actually do something.

One of the strengths of the book is Starr's portrayal of his dual diagnosis. He began drinking at age eight, when he was handed a shot of whiskey by his intoxicated father. By then he had already smoked his first cigar, and two years later he started using chewing tobacco. By the time he was 15, he had episodes of drinking himself into a stupor, had blackouts, and had become violent while intoxicated.

Perhaps the major strength of Starr's work is the portrayal of his recovery. His is a book of hope in that there is a remarkable distance between his life's nadir and its zenith. Starr talks committedly and convincingly about the need to tend to one's recovery and to move past focusing on the failures of the system. He cautions that if an individual myopically views what's wrong with a department of mental health, the criminal justice system, staff of these systems, the local attorney general's office, court-appointed psychologists, and so on, one will never be free.

Starr's Not Guilty by Reason of Insanity is a good book for professionals to recommend to patients who have chronic mental illness, and particularly those involved with the criminal justice system. These individuals often feel that there is little hope, that for those who are caught in the combined mental health and criminal justice system, the bars that confine them have no end. Randy Starr tells a story that could provide them with some guidance, at least in terms of one man's experience of finding that hard work yielded highly satisfactory outcomes.

Lori Gottlieb, a medical student at Stanford University, has produced in Stick Figure a very skinny book. There's just not really a whole lot here.

According to the epilogue, Gottlieb found her childhood diaries when she was almost 30 years old. Stick Figure is the diary for the year 1978, when she was 11 years old. Or at least that diary provides the foundation for this book, which sometimes sounds like it was written from an 11-year-old's perspective, and sometimes like a 30-year-old's perspective on her 11th year.

Gottlieb's thesis is that for an elementary school girl growing up in Beverly Hills in the 1970s, "what's a girl supposed to wish for other than being thin?"

The struggles around eating sound typical. In response to her mother telling her that she needs to follow the doctor's directive because the doctor gave a directive, Gottlieb says, "I told Mom that I don't care if he's a doctor, I'm not taking orders about food from someone with a turkey chin whose belly hangs over his pants. I mean, what could he possibly know about nutrition?"

Food assumed great importance in her life: "I had meals planned for the next month, I even had lists of things I didn't plan on eating for the rest of my life." Sometimes her comments about food are humorous, such as in her description of an interaction with her physician: "He just blew out a bunch of air that smelled like corned beef, and I held my breath in case any calories went up my nose."

Gottlieb ends up hospitalized, and this event leads to her revelation one day when looking in the mirror: "I looked disgusting. I used to want to be a stick figure, but now I'm not so sure."

Stick Figure offers little in the way of new material for professionals interested in adolescents and anorexia nervosa. However, it does provide a useful read for adolescents struggling with eating disorders and related questions of self-image. Professionals might wish to become familiar with the book as a useful resource for young patients.

Paul Solotaroff's Group is not actually a first-person account, but because it comes close to this genre, it is included among these reviews. The author, a former editor of the Village Voice, has panic disorder, which was treated with individual psychotherapies and clomipramine before he joined a group. His group therapy experience was a positive one, and he approached the psychiatrist who had led the group about writing a book retrospectively about his group experience.

The psychiatrist thought this method would be problematic and suggested that Solotaroff instead be a silent witness to a group that was about to start. The psychiatrist obtained permission from the six group members who were about to embark on a time-limited course of group psychotherapy. Solotaroff was given access not only to the group sessions but also to individual meetings with each of the group participants and to meetings with the psychiatrist.

Solotaroff sets out his intent in the preface. "This is not a book about [the psychiatrist's] methods, nor to be mistaken for a self-help text. Rather, it is a work of narrative journalism that documents, at close hand, a year in group therapy. As such, its intentions are strictly literary: to tell the following stories with power and specificity, and leave other implications to those so inclined."

The group that Solotaroff observes and the lives that he writes about are not what one would generally consider to be a typical group. All six members, four men and two women, had successful careers at some point. Among them are a senior financial analyst, a director of a community mental health center, a Broadway producer, a commercial songwriter, and a Wall Street millionaire. Their nonprofessional activities include histories of embezzlement, cocaine and alcohol addiction, husband searching, divorce, and marriage. While these activities don't sound atypical, almost all of them involve significant sums of money.

Solotaroff uses a notepad and a tape recorder while observing the group. His subjects participate in 20 sessions of two and a half hours each over ten months. During that time, four of the six participants gain significantly from the experience.

Solotaroff is a good storyteller, but the book is not without problems. Although Group is subtitled "Six People in Search of a Life," it sometimes degenerates into reading like a script for "Queen for a Day"—the old television show in which the woman who could tell the greatest sob story was crowned queen. Unfortunately, in this group, the greatest sob story turns out to be that of the seventh member of the group—the psychiatrist leader, who succumbed to alcoholism after the group ended. While there's no reason to doubt that it occurred exactly as Solotaroff reported it, to some degree the account of the psychiatrist's deterioration included in the epilogue seems gratuitous, and it detracts.

For readers who wish to read an engaging book with very interesting characters, Group is a good choice. For readers who wish to read a piece of nonfiction that characterizes group therapy as it is generally practiced, with a cohort of typical group therapy participants, this is not the book. Group is probably best described as an ethnocultural study of well-to-do New Yorkers participating in a group run quite idiosyncratically by a chief whose life deteriorates while the lives of two-thirds of the members of his tribe improve.

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School in Worcester.




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