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Book Reviews: Women Speak … Briefly   |    
Skywriting: A Life Out of the Blue • Until Tonight: A Memoir • Beautiful Stranger: A Memoir of an Obsession With Perfection • Poker Face: A Girlhood Among Gamblers • In the Shadow of Fame: A Memoir by the Daughter of Erik H. Erikson
Jeffrey Geller, M.D., M.P.H.
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.1.145
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by Jane Pauley; New York, Random House, 2004, 288 pages, $25.95 • by Laure Adler; New York, Granta Books, 2002, 144 pages, $16.95 • by Hope Donahue; New York, Penguin Books, 2004, 292 pages, $25 • by Katy Lederer; New York, Random House, 2003, 209 pages, $23.95 • by Sue Erikson Bloland; New York, Viking Penguin, 2005, 240 pages, $24.95

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Of the five books I review here, the one that made the biggest splash was Jane Pauley's Skywriting. This autobiography produced widespread ripples due to Pauley's revelation that she has bipolar affective disorder. Pauley's acknowledgement of a mental illness is part of a recent trend whereby celebrities tell the public about their psychiatric pathology. For example, about the same time that Skywriting hit the bookshelves, Linda Hamilton, known for her role as Sarah Connors in the Terminator movies, revealed that she had depression.

Pauley's discussion of her psychiatric illness and its treatment are in fact only a tiny part of her autobiography. Despite genetic loading, including having both a father and a maternal great-grandfather with alcoholism as well as a maternal grandfather with depression, Pauley ascribes her highs and lows to steroid treatment for chronic, recurrent idiopathic urticaria edema, better known as hives. Her entire inpatient experience was a pseudonymous VIP treatment as a psychiatric patient in a special area of Payne Whitney Psychiatric Clinic.

What is interesting about Skywriting is Pauley's portrayal of herself as a largely naive woman with fragile social confidence, more comfortable at work than anywhere else and more comfortable interviewing people than socially interacting with them. She describes an evolution from naiveté to insight, and in the process of doing so she reveals that her trip has been only partially made. Conscious revelations are less interesting than unconscious ones. Pauley marvels at how somebody with her background and her character could have become a television personality. She fails to acknowledge that the public interview is far from an intimate process and that perhaps she was led to the form of investigative journalism she does because she grew up in what she realized in the late 1970s was a family "based upon a major misconception."

Pauley describes herself as always somewhat on the outside and always somewhat alone and communicates this to the reader in the third sentence of the book: "I was the only member of my family." Pauley gets it exactly right when near the end of her autobiography she states, "I was so preoccupied with 'just be yourself' because I wasn't sure who that was." Skywriting is filled with detours, but for readers who are interested in psychological development, Pauley's self-portrayal is a fascinating accounting of a bud partway through its blossoming.

Until Tonight is Laure Adler's poignant account of a mother's experience of the death of her nine-month-old son, written 17 years after the loss. A petite book in physical dimension and pagination, it is nonetheless sometimes overwhelming. Adler makes observation after observation about the pain of life. For example, "Pain is indeed a living thing: pulsating and concrete, and as uncomfortable as a large mad dog that, for fun, will suddenly sink its fangs into you and draw blood."

Adler's son succumbed to acute respiratory distress syndrome. She describes the experience as an agonized poet would: "My son was intubated. I didn't know it would be permanent. Never again would there be air between him and the world. All his independence was lost." And she beautifully describes the loneliness of being a patient's significant other and the suffering that families endure. She adroitly portrays experiencing physicians, with their high-tech interventions, "pretending to know." It is painful as a reader to experience a parent's anguish as her child suffers and the exacerbation of the anguish as the parent experiences the indifference of the medical team. Adler indicates, "But in this place, silence is a form of contempt. Worse, the silence intensifies your anguish and feeds your fears. If the doctors aren't telling you anything, then it must be because it's even more serious than you thought." When faced with the final moment of switching off the machines that were her son's life force, Adler indicates, "Like a fly crashing into a dirty window, I tried to escape into the outside world."

Anyone who is involved in the care of patients would benefit from reading Until Tonight. This book should be assigned reading in medical schools, nursing schools, and schools of social work.

There are some autobiographies that make the reader think, "I can see why it would have been therapeutic to write this, but why did the author seek to have it published?" Beautiful Stranger, by Hope Donahue, is such a book. Donahue portrays her search for perfection through plastic surgery. She takes us through her journey of transformation, during which she gets bigger breasts, bigger lips, a smaller nose, cheek implants, and a brow lift. She is literally and figuratively putty in plastic surgeons' hands—plastic surgeons who are often narcissistic, caustic, and sadistic and who browbeat their patients into having cosmetic surgery. Ironically, it was Donahue's quest to achieve the pinnacle of broadcasting—or, as her mother told her, to become the next Jane Pauley—that pushed her toward each step of remodeling of her physiognomy. It took Donahue three decades to realize that her self and her appearance "were two separate things, that I could not fix the former by tweaking the latter." Unfortunately for Donahue, most people who might consider reading Beautiful Stranger already have that knowledge.

What Donahue needed was psychotherapy, not plastic surgery. Plastic surgery could never address the theme of Donahue's life: "I did not feel important enough to be of consequence to myself, let alone anyone else." Donahue does gain insight through psychotherapy, but, unfortunately, she sees this as a less important part of her story. She goes from unaware to aware in a paragraph.

Those who might benefit from reading Beautiful Stranger are individuals who believe that life transformations will accrue as simple derivatives of altering one's physical appearance. Any patient who needs a second source to reexamine this thesis could be referred to this book.

Poker Face, by Katy Lederer, starts out with a 13-year-old daughter, the youngest of three children in a Jewish family in which the father is an English teacher and author of grammar puns at an old-money, WASP-y prep school in New Hampshire and the mother, who is the daughter of an alcoholic mother, herself suffers from alcoholism as well as agoraphobia. In this book, the family is transported from New England to Las Vegas, where several family members become professional poker players.

Lederer takes us through many developmental stages and mood states. She describes herself early in her life: "I had a surplus of innocence and was hoarding it for the day I'd be forced to take action. The more innocence I accrued, logic went, the less guilty I'd be in some rancorous future." She brings us through insights about her mother: "I regularly mistook her brilliance for wisdom and was unable to understand how a woman who possessed so much wonderful knowledge could have such a difficult time keeping her life together." She struggles with depression: "I spent most of my first year asleep. The moment classes began, it was as if I'd been overtaken, like Dorothy, by the odor of poppies. In retrospect, I was suffering under the weight of depression blacker than any I could have imagined for myself, though I didn't label it then …. [I] simply believed that I was lazy, and I hated myself for it."

Lederer's tracing of her development is interesting. It's the poker that catches her up. She treats poker only literally and does not use it as the metaphor it seems to be. Are we, the readers, supposed to read this metaphor into the book and into the family? That is not clear. Lederer presents too many fragments that are not followed up, but her greatest challenge is to make the book's poker aspect interesting to the reader. Lederer herself points out, "There's an old saying that watching a person play poker is just about as interesting as watching paint dry." In Poker Face Lederer was unable to overcome that hurdle.

Much of the action takes place in Las Vegas, which, unfortunately, does not come across as a terribly interesting place. What might interest readers of this journal is Lederer's comparison between poker players and psychiatrists: "Just as New York psychiatrists go to the Hamptons for the summer, professional poker players go off to Maine or Montana to relax and escape the ruthless heat."

In writing Poker Face, Lederer had access to an interesting set of lives and an excellent metaphor, but she has simply failed to play her hand well. She had a full house and didn't know what to do with it.

Sue Erikson Bloland's book, In the Shadow of Fame, is subtitled A Memoir by the Daughter of Erik H. Erikson. Clearly this subtitle is intended to engage prospective readers. However, it is ironic that while bemoaning the burden of growing up in the shadow of fame, Bloland uses that burden to market her book. Bloland has written a fascinating account of growing up in the Erikson household. The interest, however, has less to do with being raised in the household of a famous father and more to do with growing up with parents who—as Bloland describes them—were fragile, narcissistic individuals who were unable to acknowledge their daughter as a person. The book might better have been titled "In the Shadow of Abandonment."

Erik H. Erikson, who never knew who his father was, gave himself the last name of Erikson, meaning son of Erik. His wife, Joan, in part redefined herself, changing her first name and joining her husband in a self-created last name. Bloland's father died when she was nine years old. She received virtually nothing psychologically from her mother. Both Erik and Joan had grown up with rich fantasy lives, rejecting their current realities—not conducive to great parenting.

The tension for Bloland was between her perceptions of her father and the world's perception of him. Most readers of this journal will have some familiarity with the professional reputation of Erikson. What one learns in In the Shadow of Fame is that Erikson had a delightful sense of humor, a self-deprecating style, an instinctive attunement to others, the ability to evoke a sense of intimacy even in his briefest encounters, a knack for speaking with words that were thoughtful and well chosen, and a capacity for wisdom and empathy. However, he functioned as an awkward, unpredictable, irritable, self-absorbed, distant father who fulfilled no household responsibilities and made no decisions on his own.

Joan Erikson comes across as having the same schism between her public persona and her personal identify, particularly as a mother. Perhaps the quintessential example of the fragility of this couple and their difficulties in facing challenges to their self-created personas of psychological perfection and helpfulness to others is the fact that they gave up at birth a son with Down syndrome. In fact, they lived their lives hardly even acknowledging the existence of this child, to the point that many of their most intimate friends never even knew of his existence. The author, however, is well aware of this brother and struggles with her parents' literal abandonment of him, as opposed to her own psychological abandonment.

It bears repeating that Bloland focuses on fame in this book. She notes, "It has always been clear to me that many of my father's admirers held themselves to be less successful than he was—not only as thinkers but also as human beings. This awareness led me to realize how often in modern life we compare ourselves to the glorified images of the famous and feel diminished by the comparison." Although some may agree and others may argue with this point, Bloland, to some degree, derails the thrust of her very powerful tale by tying it to fame. Had Sue Erikson Bloland's name been Jane Doe Smith, she could have written the same book about a daughter's struggle to be seen, heard, appreciated, and loved by a set of parents who had no capacity to do so. It might well have been harder for her to find a publisher, but the power of In the Shadow of Fame would not have been diminished. It is not that Erikson was famous that burdens Bloland, but, rather, that as a father, Erikson was a blind man without a guide dog or a cane who appeared to have no interest in finding his own way, who refused help when it was offered, and who was so involved with himself that his acumen was never used in fatherhood.

Bloland's pain lies in the fact that she had two parents who failed her miserably; the salt in her wound was that it didn't seem that either one of them noticed or cared. Those dynamics have nothing to do with fame. I highly recommend this book to anybody who has had a parent or been a parent—which includes virtually all of us.

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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