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Book Review   |    
City of One: A Memoir
Jeffrey L. Geller, M.D., M.P.H.
Psychiatric Services 1999; doi:
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by Francine Cournos, M.D.; New York City, W. W. Norton, 1999, 253 pages, $23.95

Francine Cournos is a Bronx-born Caucasian woman, the middle child of three from a lower-middle-class Jewish family. Her father died from a cerebral hemorrhage when she was three years old, and her maternal grandfather, in whose home she lived, died two years later. Soon afterward her mother developed rapidly metastasizing breast cancer and died when Cournos was 11 years old. Although Cournos had three sets of aunts, uncles, and cousins who lived nearby, she was placed in foster care.

In her fifties, Dr. Cournos, a psychiatrist, decided to write a book about her life; hence City of One. Cournos' decision to display her personal development—from its beginning through every identity-depriving conundrum to the present—is courageous, and her product is extraordinary.

Cournos takes the reader through her life chronologically. But while the book appears to march straightforwardly through time, Cournos intersperses her account with recollections from the past as they inform her present. She also projects forward in her account to inform the reader how events in her youth impacted on her future; when the reader arrives at that future time, he or she gets a second view of events heard about earlier. Thus the book parallels developmental and cognitive processes: the present is informed by the past, and the inhabitant of the present carries his or her history into the future through fantasized projections and real interactions.

The central theme of Cournos' book is how the death of a parent affects one throughout one's lifetime. Hers is a one-person story of a theme offered in an earlier book by Harris (1), The Loss That Is Forever. However, one can "lose" a parent in other ways besides death, such as through serious mental illness, as described by Lyden (2), and through alcoholism, as reported by Agnew and Robideaux (3). City of One can be read as applicable to the loss of a parent or parents even through their abject neglect. Much of what Cournos describes has a universality far beyond her own circumstances.

Cournos, as author, is able to draw the reader in by taking the reader along her life of struggles, revelations, hiding places, discoveries, zeniths of counterdependence and nadirs of depression, struggles for intimacy, and quests for acceptance as if she is talking to herself out loud and we, the readers, are just listening. Little—remarkably little—appears censored. Cournos' intimacy with the reader advances through the book in the same fashion that her self-knowledge advanced through the decades she describes.

Nor does Cournos fail to comment on her own story. She makes generalizing statements, clearly bringing to the book her expertise as a psychiatrist, and she attempts to teach. For example, she writes that "each stage of life reawakens old memories that need to be faced yet again, and the trauma of early parental loss reasserts itself in different forms throughout a lifetime." And, "There must be something wrong with me, I concluded, or my family wouldn't have given me away. In a sense, it was better if it was my fault, since I firmly believed that what I had caused I could surely correct." And, "Orphan adolescents have a terrible dilemma: they have a developmental need to break away, but their parents have beaten them to the punch."

Of the many struggles Cournos describes, two themes carried throughout the book are particularly poignant. The first is loyalty. For the author this loyalty is to her mother. Hence Cournos' quest involves reaching some stage in life that would allow her to turn her attention away from her mother to those in her present. Cournos writes, "Once in a while, I was invited to a gathering of my entire family, where I went through the motions, polite and utterly detached. What felt most real was my sense that I carried Mom (and sometimes my Dad, too) with me everywhere I went, a little homunculus inside my brain. Mom participated in all my activities, living on through me."

The second particularly moving theme is the overwhelming tension between independence and dependence. Cournos writes about herself, "One side insisted on managing without being close to anyone, said it's just not worth it, people are too unreliable, only a fool would persist in the face of all the evidence that it never works out and never will. But the other part of me was desperate, needy, driven by desire, afraid to be alone. I hated my contradictory feelings and wished I could banish them, but there was no escape."

Through much of her life Cournos managed to survive, as she describes, by "saying nothing about something—my mother and I had perfected this technique. Saying something might just make it worse." Fortunately for us, Cournos has decided to speak, and to do so meaningfully. If anything, she sells herself a little short, something she informs the reader she has done her whole life. She states in her epilogue that she hopes this book will be useful for "those personally and professionally concerned to understand the difficult and dangerous journey that lies ahead of a child whose parents have died." I would extend that epilogue to say that this book can be extremely useful for understanding anyone who has lost a parent or parents, no matter how that loss came to pass.

I cried while reading this book. I could go on to fill this review with panegyrics. I'd rather simply say I've no better recommendation for City of One than that I can't think of anyone who shouldn't read this book.

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

Harris M: The Loss That Is Forever. New York, Dutton, 1995
Lyden J: Daughter of the Queen of Sheba. Boston, Houghton Mifflin, 1997
Agnew E, Robideaux S: My Mama's Waltz. New York, Pocket Books, 1998


Harris M: The Loss That Is Forever. New York, Dutton, 1995
Lyden J: Daughter of the Queen of Sheba. Boston, Houghton Mifflin, 1997
Agnew E, Robideaux S: My Mama's Waltz. New York, Pocket Books, 1998

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