Recommended Reading

A post at Shrink Rap invites suggestions for recommended reading on psychiatric topics, prompting me to chime in with my top ten. These are not "recommended" per se; these are the books, some read before I became a psychiatrist and some read after, that struck or influenced me most deeply. This sort of list can only relate to the sort of person I was to begin with; other people might read these ten and be disappointedly unfazed, but I can't help believing they are noteworthy in their own ways. In no particular order:

1. "Civilization and its Discontents," encountered in undergrad, was my first experience of Freud, and still the most memorable. He unforgettably explained how the basic human dilemma is not so much intrapsychic as social and interpersonal. As Sartre infamously put it, "Hell is other people," although fortunately it's not so simple.

2. The Birth of Neurosis, by George Frederick Drinka, impressed me with the cultural contingency of hysteria and psychological symptoms in general.

3. The Savage God: A Study of Suicide, by A. Alvarez, used the case study of Sylvia Plath as a springboard to an existential and phenomenological consideration of the suicidal mindset.

4. Listening to Prozac, by Peter Kramer, raised fascinating and vexing questions about the relation of diagnosis to medication.

5. The Myth of Mental Illness, by Thomas Szasz: any serious psychiatrist must know, and come to grips with, the argument that the whole enterprise is fundamentally misguided.

6. Darkness Visible, by William Styron, may be forever the best account of the experience of depression. No sentimentality or silver linings here (although he did recover).

7. "Ward Six," by Anton Chekhov: There but for the grace of God...

8. "Miss Lonelyhearts," by Nathanael West, is a deeply quirky examination of the emotional hazards of the therapy project, broadly considered (in this case, pertaining to an advice columnist).

9. The Perspectives of Psychiatry, by Paul McHugh and Philip Slavney, convincingly argues for the irreducible complexity of psychiatric understanding.

10. With all due respect to Irvin Yalom, I would pick Kafka's brief, gnomic parable "Before the Law" as the ultimate existentialist text: in the end, it's unavoidably up to you.

11. (Honorable Mention): Hamlet, by William Shakespeare: the unfathomably neurotic young psychiatrist as doomed Danish tragic hero.

Heart of Darkness

"The old doctor felt my pulse, evidently thinking of something else the while. 'Good! Good for there,' he mumbled, and then with a certain eagerness asked me whether I would let him measure my head. Rather surprised, I said Yes, when he produced a thing like callipers and got the dimensions back and front and every way, taking notes carefully. He was an unshaven little man in a thread-bare coat like a gaberdine with his feet in slippers, and I thought him a harmless fool. 'I always ask leave, in the interests of science, to measure the crania of those going out there,' he said. 'And when they come back too?' I asked. 'Oh, I never see them,' he remarked, 'and, moreover the changes take place inside, you know.' He smiled as if at some quiet joke. 'So you are going out there. Famous. Interesting too.' He gave me a searching glance and made another note. 'Ever any madness in your family?' he asked in a matter-of-fact tone. I felt very annoyed. 'Is that question in the interests of science too?' 'It would be,' he said without taking notice of my irritation, 'interesting for science to watch the mental changes of individuals on the spot, but...' 'Are you an alienist?' I interrupted. 'Every doctor should be--a little,' answered that original imperturbably. 'I have a little theory which you Messieurs who go out there must help me to prove. This is my share in the advantages my country shall reap from the possession of such a magnificent dependency. The mere wealth I leave to others. Pardon my questions, but you are the first Englishman coming under my observation...' I hastened to assure him I was not in the least typical. 'If I were,' said I, 'I wouldn't be talking like this with you.' What you say is rather profound and probably erroneous,' he said with a laugh. 'Avoid irritation more than exposure to the sun. Adieu. How do you English say, eh? Good-bye. Adieu. In the tropics one must before everything keep calm.' ...He lifted a warning forefinger...'Du calme, du calme. Adieu.'"

Joseph Conrad

Escape Artists

"But my mama never warned me about my own destructive appetites."

Jenny Lewis


Let us mark Mother's Day with a nod to one of the least praiseworthy of fictional mothers, Emma Bovary. Forever foisting her daughter--who was an unacceptable intrusion upon her own self-absorption and self-indulgence--upon the maid, Madame Bovary was one upon whom motherhood was truly wasted. Fortunately she had only one offspring to neglect and not several.

Indifferent mother, unloving wife, adulteress twice over, disastrous spendthrift, melodramatic and self-pitying hysteric, and ultimately miserable suicide, Madame would be utterly despicable if it weren't so tempting to identify with her. Her basic problem was an appetite that could not be satisfied by the milieu in which she found herself. The first step toward forgiving her is, of course, the basic feminist recognition that like all women, she was born into a world designed to frustrate female motivations at many turns.

Madame Bovary was a hapless Romantic, an escapist, a fantasist forever pining for some vaguely imagined realm of glamour. She happened to be paired up with the worst possible mate for her, the profoundly unimaginative Charles. Devoted and reliable, he would have proven a serviceable husband for a number of women, but for Emma he was poison.

Charles and Emma ended in calamity and not mere unhappiness because both of them were impractical dreamers. There was no check on the development of parallel marital fictions. Charles achieved his fantasy of domestic bliss through total denial of what was going on in front of his eyes; his only claim of diminished responsibility derives from his low intelligence.

Emma, after all, wants to be able to accept reality as it presents itself to her senses, but she is unable to. She endeavors to love her husband, but the love will not come. She prays for virtue; she fitfully and impulsively tries to summon maternal instincts. The spirit on some level is willing, but the flesh craves more than her straitened bourgeois existence can provide. And that is part of the problem, that she wants it both ways, that is, the respectability and stability of a doctor's wife as well as total freedom and exotic adventure.

One can imagine her as a writer or an actress, pursuits that were open to women even in that pre-feminist era. But she either lacked the courage of her convictions, or she did not understand herself well enough to recognize where she might find what she needed. Perhaps she was a failed artist, or one endowed with an artistic temperament without accompanying discipline or skill. The problem is not really escapism itself, for the pharmacist Homais, who smugly and pedantically revelled in every grubby aspect of "the given," comes off as an odious figure. For it is human nature to be impatient with reality, to be bored, to need perpetual stimulation of one kind of other. Thus religion, thus the arts, thus games and sports (Homo ludens indeed), thus war, drugs, and sexual intrigue. Some are arguably born more bored than others, and inasmuch as relief of boredom is one of the central tasks of life, Madame Bovary made a particular mess of things. Consciousness is restive by nature; the trick is to afford this restlessness its due scope without hurting others or oneself unduly along the way.

Sometimes a Fantasy

She didn't read books so she didn't know that she was the world and the heavens boiled down to a drop. Man attempting to climb to painless heights from his dung hill.

Then one day she sat and watched the shadow of herself going about tending store and prostrating itself before Jody, while all the time she herself sat under a shady tree with the wind blowing through her hair and her clothes. Somebody near about making summertime out of lonesomeness.

This was the first time it happened, but after a while it got so common she ceased to be surprised. It was like a drug. In a way it was good because it reconciled her to things. She got so she received all things with the stolidness of the earth which soaks up urine and perfume with the same indifference.

-----

Most humans didn't love one another nohow, and this mislove was so strong that even common blood couldn't overcome it all the time. She had found a jewel down inside herself and she had wanted to walk where people could see her and gleam it around. But she had been set in the market-place to sell. Been set for stillbait. When God had made The Man, he made him out of stuff that sung all the time and glittered all over. Then after that some angels got jealous and chopped him into millions of pieces, but still he glittered and hummed. So they beat him down to nothing but sparks but each little spark had a shine and a song. So they covered each one over with mud. And the lonesomeness in the sparks made them hunt for one another, but the mud is deaf and dumb. Like all the other tumbling mud-balls, Janie had tried to show her shine.

Zora Neale Hurston, Their Eyes Were Watching God

Those two excerpts, it seems to me, contain the debate over the nature of art: morbid escapism ("It was like a drug") or ultimate bid for redemption? Going against the traditional grain of literary opinion, Rob Nixon makes the case for non-fiction as the genre that, more often than not, captures reality better than fiction. The issue, of course, is that reality is a mansion of many rooms. There is sociological reality and there is emotional reality.

In my own case I would say that as I've grown older my need for non-fiction has increased, while my patience with fiction has decreased, and given the choice between a mediocre example of either, I will go with non-fiction. The problem with fiction, as with film, is that so much of it is mediocre, and as one ages, the pressure of reality increases, making it harder to justify the expenditure of time in the pursuit of mediocrity.

However, fiction (in which I include poetry and drama) at its best surpasses anything that non-fiction can offer, and given a medium-sized suitcase for a sojourn on the proverbial desert island, I can think of very few non-fiction works that I would pack (Walden is the only obvious one that comes to mind). This is because, as I and many others have written, fiction offers an extra dimension of meaning. Indeed, non-fiction could be likened to tradition 2-D film: solid, reliable. Fiction, like 3-D, offers a far more intense experience, but it also carries the risk of being merely goofy.

A long time ago I came across a remark by Tolkien, whether in his letters or in an essay I don't recall, in which he protested the common dismissal of escapism as a literary motivation. He argued that if the reality in which one finds oneself seems to be a prison, what is wrong with trying to escape from it? There are all kinds of problems with this, including the Platonic and Christian assumption that if one escapes from the cave, one will find oneself anywhere else but in a larger cave. But I think he has a point that the artist seeks not merely to reconcile himself and others to the world as it is--the work of art adds to the world as it is, and in so doing it aspires to redeem it. Art is not a housecleaning--it is a remodeling, even an annex, while non-fiction is a diagnosis. Each has its place.

Oh, and what is the genre that seeks to combine the reality of diagnosis with the supreme emotional truth of art? Wouldn't that be religion? But can that circle be squared?

Metafictions

A Commonplace Blog sets me to thinking, as usual, this time about literary style and its relation to genre and, by implication, to the whole point of writing and reading. D. G. Myers laments the profusion of slapdash Web chatter, likening it to street noise haphazardly translated into prose. In this I concur. But in promoting the self-conscious artifice of good writing, he claims that fiction is the "permanent home" of the best prose. It is an assertion that may come as a great surprise to many poets and essayists, among many others.

What does good writing do, and wherein is its appeal? I always come back to Horace's claim that the point of art is to delight and to instruct. Both are necessary, neither sufficient, although different genres and styles may call for more emphasis upon one or the other. The "instruction" of art involves education about the world as it is, whereas "delight" entails the delectation of perception and expression for their own sake.

Good writing, whether fiction or non-fiction, enhances our understanding of and attachment to reality, but by means of desire and acceptance, not mere resignation. Good writing is ultimately about attentiveness, about getting reality right, not in itself (as if we could know what reality is in or for itself), but crucially with respect to human needs. As a basic level good writing is an ode to the world as beloved; this involves both accurate appraisal and enthusiasm.

Fiction does hold a special and honored place because for (self-)conscious creatures, "reality" is forever in flux and in question; it is an amalgam of what is the case and what could potentially be the case. And technically of course, there is in fact nothing outside of reality. The vast realms of fiction are--or at least began as--mere annexes built upon a prior reality. They become candidates for more or less embraced realities themselves.

What about virtual reality? Consciousness is itself the original virtual reality. There is only reality, but therein are countless regions that are more or less hospitable to human thriving and happiness. That is how we judge narrative, whether in the form of writing, film, or video game; does it either depict or stipulate (depending on whether its focus is more realistic or fantastic) reality in a way that is stimulating, enlightening, and favorable for human experience, such as it is? And of course human experience, being historical, has itself been shaped by previous depictions and stipulations. This implies that human sensibility could change, whether biologically or culturally, such that favored narrative styles may alter profoundly over time; the question is how elastic "human nature" ultimately is.

The psychologically interesting thing, of course, is that writing and reading are not like air or food; some seem to need or crave them, particularly in fictional form, far more than others do. For some, perhaps, reality that is "unenhanced," one might say, is merely dull and difficult to love, such that it is imperative to "make it new," as Pound put it I think. This may reflect a certain critical restlessness of temperament. Others may be connoisseurs of reality, so to speak, who revel in nuance for its own sake. What these two groups seem to agree on is that reality is no settled matter. What then is bad writing? It is writing, I suppose, that either gets reality clumsily or wrong-headedly wrong, or that proposes an alternative reality that we ultimately cannot love or learn from.

As I wrote a couple of posts ago, I have found it harder to enjoy fiction in recent years, and it has been hard to pin down why. And this is particularly true of contemporary fiction; the older I get, the number of books I find indispensable continues to shrink, and the attraction of the latest Pulitzer Prize winner grows ever dimmer. Perhaps in thirty years I will be down to Shakespeare alone. But then again, maybe current life circumstances will moderate such that the central preoccupations of literature--the fine-grained, yet speculative appreciation of how things stand with respect to human beings, as well as subtle suggestions of how they might or ought to be different--will again beckon as open, urgent, and interesting questions.

By the way, farewell to 2009, a year stranger than any fiction.

In the Beginning...

There may be no better instance of "high" art meeting "low" than R. Crumb's new version of the Book of Genesis (complete and unabridged, primarily using Robert Alter's translation)--an NPR review is here. Crumb, best known for his notoriously carnal and countercultural work in underground comics, explained that the warning on the book's cover--"Adult Supervision Recommended for Minors"--is needed because of the story, not his artwork. And indeed, his version is straight up, honestly depicting the extensive sex and violence of the original without gratuitous detail.

In his generally favorable review from The New Republic, Alter himself explores and questions the extent to which Crumb's illustrations add to the power of the original. However, is this really the primary criterion by which graphic work--whether drawn, staged, or filmed--should be judged? After all, as Alter implies, any one graphic interpretation, inasmuch as it favors one visual version, steers the reader away from imagined alternatives. Indeed, such is the power of primary text that any "strong interpretation" could potentially detract as much as add.

While graphic works can't be considered altogether in isolation from their source texts, I think they also can stand or fall based on their own visual impact. For instance, I love William Blake's illustrations, but I think they retain much of their power even if the words (prodigious in themselves) are blocked out. And some primary texts seem to me to be so profound and uncontainable in themselves that visual interpretations seem almost a distracting disservice. Shakespeare is like this--while I've enjoyed a fair number of staged and filmed versions, I would much prefer to reread the original.

Another way of saying it is that graphic interpretations, while perhaps professing to complement or even enhance the textual original, cannot avoid competing with it and threatening to limit it as well. Perhaps this is why Islam forbids illustrations of the divine. But interpretation, just as criticism itself, can be appreciated as a parallel pursuit, just as I might enjoy Mozart's Mass in C Minor without counting myself a believer. As Santayana I think put it, "There is no God, and Mary is his mother."

When I first read Genesis as a teenager I was most struck, for whatever reason, by the story of Lot's family's flight from Sodom and Gomorrah and his wife turning into a pillar of salt when she turned to look behind her. Perhaps there was some adolescent avidity to know what exactly was going on in Sodom and Gomorrah, but as someone with a weakness for nostalgia to begin with, I also took it as a minatory tale. Descending from high to low culture, I would then proceed to play Boston's "Don't Look Back" at high volume.

So the Book of Genesis, a work of towering influence, doesn't need R. Crumb to augment its stature, but the graphic work is compelling in its own right, establishing its own imaginative region even if, in narrative terms, it does little more than flatter the original. But one definition of a classic--I forget where I read it--is a work that continually generates a buzzing cloud of interpretation.

Bumps in the Road of Science

From Edward Mendelson, The Things That Matter: What Seven Classic Novels Have to Say about the Stages of Life (2006):

In the early nineteenth century the most up-to-date and modern psychological science was phrenology, the pseudoscience that identifies your emotional and moral character by mapping the bumps on your skull, in much the same way that more recent pseudoscience traces your voluntary actions back to the unchosen, involuntary workings of selfish or altruistic genes. A university chair in phrenology was established at Glasgow in 1845, and Charlotte Bronte, like most of her contemporaries, took it for granted that phrenology was valid science; Jane Eyre is conscious of her "organ of veneration" when Helen Burns recites Virgil, and observes on Rochester's forehead "an abrupt deficiency where the suave sign of benevolence should have risen," and Rochester observes in Jane "a good deal of the organ of Adhesiveness." But for Charlotte Bronte, phrenology was merely a familiar feature of her intellectual landscape. Marian Evans [George Eliot] took it far more seriously as a new instrument of knowledge that called for her active participation in it. At the time she was translating Strauss's Life of Jesus, she arranged to have a full phrenological analysis made of herself, based on a plaster cast of her cranium, and the preparations for the analysis included shaving her head.