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Book Review   |    
Maxine Harris
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.7.819
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by Paula Kamen; Cambridge, Massachusetts, Da Capo Press, 2007, 304 pages, $26

Dr. Harris is the chief executive officer for clinical affairs of Community Connections in Washington D.C., and the author of several books on issues of loss and trauma.

Iris Chang, author of the landmark book The Rape of Nanking, was a brilliant journalist and a prize-winning author. In her book, Finding Iris Chang: Friendship, Ambition, and the Loss of an Extraordinary Mind, Paula Kamen tries to understand the seemingly unexpected suicide of this remarkable woman. Kamen, herself an author and journalist, was also a close friend of Chang's, and her personal relationship to her subject colors her efforts in ways that are at times touching and poignant and at times naive and overinvolved.

Chang, an outspoken political figure who wrote passionately about the atrocities committed against the Chinese by the Japanese during World War II, had achieved iconic status in the Chinese-American community and was much admired and perhaps envied by many fellow journalists. Tragically, her brilliance and her special status caused almost everyone to overlook what to the clinically sophisticated reader will emerge almost immediately in the narrative, a spiraling out-of-control bipolar illness.

The book invites an interesting consideration of just what constitutes mental illness. When does one cross the line from eccentricity to serious mental illness? When Chang was up all night for days, increasingly paranoid and searching for increasingly bigger guns with which to successfully kill herself, there was no question that she was in the grip of a powerful illness that ended with her suicide. But for years before that, when Chang was working all hours, talking incessantly to friends on the phone, pursuing every lead, she was determined to write the best book possible. She was at times overly aggressive and off-putting, pushing herself ahead with a somewhat grandiose ambition that caused some to see her as a shameless self-promoter. However, most were glad to view her as a genius with superhuman energy and the usual quirks and eccentricities that accompany exceptional creativity.

There were many reasons that Chang never received the help that might have saved her life, not the least of which was that she hid her bouts of depression very well. Chang was as wedded to the image of herself as perfect as were many around her. Being an Asian American, she was also prey when it came to psychiatric illness to the four Ss: stigma, shame, silence, and secrecy. A group of Asian-American social workers in a discussion after Chang's death noted that the four Ss make accurate diagnosis in the Asian-American community more difficult and stressful for all concerned.

Regrettably, Chang's professional success prevented almost everyone from seeing her mental illness clearly. She was prolific and brilliant, and many who profited from her success saw her eccentricities as the inevitable quirk of genius. She also wrote about painful and traumatizing subject matter, and some were willing to see her more troubling responses as following naturally from vicarious traumas that would have affected any caring researcher. The hormone treatments that she took in an effort to become pregnant were seen as the primary cause of her mood swings, which further hid her true disorder.

In the end, Kamen's is a cautionary tale, alerting all of us who work in mental health, as well as those of us who don't, to pay attention to behaviors that seem too exaggerated, too intense, and too far out of the ordinary. If those close to her had been willing to see the struggling woman behind the perfect fa├žade, perhaps Iris Chang's story would not have ended so tragically.




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