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Book Reviews: Menspeak   |    
One Case History • Gibberish: A Bipolar Survival Story • A Million Little Pieces • Goat: A Memoir
Jeffrey L. Geller, M.D., M.P.H.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.8.1026
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by John P. Gallagher; Bloomington, Indiana, AuthorHouse, 2004, 84 pages, $13.95 softcover • by Scott James Jordan; Philadelphia, Xlibris Corporation, 2004, 108 pages, $20.99 softcover • by James Frey; New York, Random House, 2003, 383 pages, $22.95 • by Brad Land; New York, Random House, 2004, 224 pages, $22.95

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In the four books reviewed here, men talk about their mental and medical illnesses, substance abuse, or simply being adrift and abused.

The author of One Case History, John P. Gallagher, was born on September 8, 1961, the fifth of five children, one of whom died from neuroleptic malignant syndrome. Gallagher has been given diagnoses of paranoid schizophrenia, bipolar affective disorder with psychotic symptoms, and seasonal affective disorder. His symptoms started when he was in high school. His psychiatric inpatient career began at age 20. In addition to one or more of the axis I diagnoses listed above, Gallagher has had significant periods of misusing alcohol and of polysubstance abuse.

One Case History is written in a fairly idiosyncratic style that often is quite revealing. The foibles shared between psychiatrists—and therapists of other disciplines—and their patients is highlighted. Gallagher remarks, "I returned to the clinic two months later. My therapist asked me if I was suicidal, paranoid, or having any grandiose thoughts. I said that I didn't understand exactly what he meant by those words." Gallagher's treating psychiatrist, in response to his question about what was wrong with him, told him quite baldly, "You have a six to eight year history of psychotic illness characterized by paranoid ideation, auditory hallucinations, and loose associations. Paranoia is prominent, currently culminating in your lawsuit against your previous employer for sexual harassment…. In addition you have delusions …. You currently take medications that greatly alleviate your symptoms…. You drink alcohol three times a week…. You smoke cannabis once or twice a week…. You usually have mildly pressured speech, but no flight of ideas…. Your description of some people border on neologisms." To all of this and more, Gallagher responds, "Yep."

One Case History is a very short book. It will take the reader a chapter or two to get into Gallagher's style, but the effort pays off. The book provides a real opportunity to get into the mind and mannerisms of a person with a chronic psychotic disorder. It should prove a useful teaching tool at both the undergraduate and graduate levels to expose those who are unfamiliar with persons with chronic mental illness to what their life actually feels like.

The subtitle of Gibberish: A Bipolar Survival Story, by Scott James Jordan, gives readers an idea of what the book is about but does not inform them that the author has AIDS and comes from a family with a genetic loading for suicide; Jordan's mother, maternal grandmother, and maternal uncle all committed suicide. At the time Jordan wrote this book, he was the beneficiary of more than 20 years of therapy.

Jordan, the youngest of four children, carries his tale from his early childhood right up through 2002. His cornucopia of struggles began early: "Puberty, alcohol, drugs, and the discovery that I was homosexual, coupled with mental illness, grief, and no self esteem, would make me one of the larger, unsolvable problems in the household." His addictions and his gay lifestyle lead him at an early age to begin a pattern of "lying, cheating, and stealing." He learned early that "being young, gay, and cute would open almost any door in the late 70s." Jordan describes his older self as "an alcoholic, drug addicted fag with AIDS from a broken home, with no formal education or writing experience."

Jordan's autobiography recounts not only the symptoms and costs of his psychopathologies, addictions, and sexually transmitted diseases but also their treatments. His psychiatric treatments began when he was ten years old and continue today. His first inpatient alcoholism treatment was in 1984, when he was addicted to "cocaine, marijuana, alcohol, cigarettes, caffeine, sex, any person, place, or thing that took me away from my pent up shame, pain, and rage." Jordan became a patient of the Gay Men's Health Crisis in New York City in the winter of 1984. He graduated from patient to staff member, an experience that gives the reader an inside look at some of the treatment services of the 1980s and 1990s for individuals with psychiatric disorders, substance use disorders, and sexually transmitted diseases on both coasts of the United States.

There are some problems with Gibberish. The editing and proofreading leave something to be desired; most annoying are the misspellings of brand names of medications. Jordan stays emotionally distant from his subject but does recount in a successfully cerebral fashion a common triad of our era, axis I disorders (mental illness and substance abuse), homosexuality, and AIDS. This triad is at the heart of Jordan's tale and makes Gibberish a worthwhile read for undergraduate and graduate students who may not yet have encountered, either personally or professionally, a Scott Jordan.

If you are going to read or recommend to one of your patients one first-person account of addiction and recovery, I recommend James Frey's A Million Little Pieces, a knockdown, drag-out, bloodcurdling, no-holds-barred portrayal of a life destroyed by alcohol and polysubstance abuse.

Frey has many strong opinions. For example, he is no fan of the genetic explanation for moods or for substance use. He is no fan of Alcoholics Anonymous. He is no fan of not taking responsibility for what you do to yourself. As Frey explicates, "Each and every time, I knew full well, whether it was take a drink or snort a line or take a hit from a pipe or get arrested, and I made the decision to do it anyway. Most of the time it was to kill the Fury, some of the time it was to kill myself, and eventually I didn't know the difference."

Frey takes the reader on an incredible journey. He paints a portrait as passionate and poignant as any of the ease of the fall from grace caused by substances and the difficulty of the reparations of the wounds caused by substances. Ultimately his is a tale of hope, but the journey is one hell of a trip. Take it and recommend it to any patient who is wavering on his or her commitment to find life without the bottle or the capsule or the syringe.

Brad Land's Goat: A Memoir is a story of adolescent brutality. The brutality is acted out on two playing fields. The first is Land's hometown. The author is brutalized in an attack that he points out nobody knows what to call. It's variously called an "abduction" (by his mother), "the incident" (by his father), and other terms, such as "the kidnapping," "the robbery," "the choking," "the trunk thing," "the woods thing," and "this thing." The second playing field is the university at which Land endures fraternity hazing that sounds more like sadistic torture than college fun.

In both these episodes, and in the life of the author and his brother, alcohol is the lubricant that eases all. Alcohol eases the young men's physical pains, humiliations, alienations, obfuscations, and procrastinations. Nobody in the entire cohort of young men in the hometown nor in the fraternity seems to have any idea where they're going, or why they're going at all. Women appear mostly as minor characters and often seem to be caricatures. The women seem as mixed up in their sororities as the men do in their fraternities. But they seem much more willing to follow the men's leads, no matter how nonsensical or potentially destructive the destinations might be.

Goat is a painful coming-of-age memoir. Two of the five blurbs on the back cover of the book suggest that teenagers should read this book. One says that "every teenager" should read Goat, and another advises that the book should be "required reading for every scared, isolated, naive teenage boy who thinks that joining a fraternity might solve his problems." I'm not sure that teenagers ought to read this book. One of the endorsements suggests that all parents, especially those with sons, should read Goat. I'm not sure about that either. I would highly suggest that university faculty, high school, and college-level coaches and any student who thinks "My life is over if I don't get into X fraternity or Y sorority" should read Goat. One caution, however: Don't read it in bed before going to sleep unless you're looking for nightmares.

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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