Thursday, September 21, 2023

How Can I Help? A Week in my Life as a Psychiatrist


by David Goldbloom and Pier Bryden; 2013
Book review by Peter McKenzie-Brown; September 25th, 2023.

Lately, the best reads I get have come from one of the many Little Libraries (book boxes) around town. That applies to the book I’m reporting on this month. Once I started reading, I was hooked.

The downside was that I lent it to a friend who promptly went on holiday. To show you the book today, I had to order it from the library. I knew it would be available, because it was a non-fiction bestseller across Canada.

A psychiatrist, David Goldbloom is a senior medical adviser at the Centre for Addiction and Mental Health in Toronto. He and co-author Pier Bryden, who is also a psychiatrist, seek to reduce public fear of psychiatry by showing what they really do, the conditions they treat, the resources they deploy and the settings in which they work.

Tracking Goldbloom over the course of a hypothetical week gives the reader a bird’s-eye view of what psychiatrists in a teaching hospital do, providing a textured picture of its complexity. In this book the reader observes Goldbloom diagnosing and critiquing a diagnostic interview, meeting with long-standing patients to monitor their symptoms and medication, teaching residents, administering electroconvulsive therapy, and confirming a diagnosis of Asperger's disorder by long-distance telepsychiatry to Kenora, Ontario, and admitting an involuntary schizophrenic patient to the acute care unit. Those activities all take place on a single morning.

Some of the patients profiled gave explicit permission to appear in the book as themselves; others are fictionalized composites. Whichever category they fall into, all seem equally real. Goldbloom's genuine and sensitive engagement with his patients is moving to behold. Yet a great many of the bonds he ha- with his clients are based on that recognition that are virtually no cures for what this book describes as the three major psychiatric disorders: bipolar disorder, schizophrenia, and depression. In these cases, the challenge is to restore mental health when relapses occur, extend periods between episodes by facilitating emotional, vocational, cognitive, and other strengths, bolster social supports, and offer hope.

The book explains many of the biases that exert internal pressure on him when he's trying to remain on an even clinical keel. More impressive is the way he frames his professional story with his personal life. While immersing himself in the moods, thoughts, worries and preoccupations of his patients, the same processes are pressuring him. All physicians are subject to emotional vicissitudes, but most specialists are not trying to treat these same intense fluctuations in others while trying to cope with their own. Goldbloom's extra measure of personal exposure makes it clear that psychiatrists and other physicians are not exactly exempt from human emotions.

Shouldn’t psychiatrists be able to manage their internal challenges with introspection, insight, and other techniques? Well, yes. But in one case he mentions, Goldbloom is so distraught by the news that one of his patients has committed suicide that he rallies many resources to regain emotional equilibrium, including paying a condolence call to his patient's family in which their shared grief helps all of those present to heal.

This book is beautifully written. Although there are two authors, most paragraphs are written in the first person: I did this, I saw that, I asked how, and so on. Throughout the book, the first person clearly seems to be Goldbloom. This confused me a bit, in the sense that Ms. Bryden is the co-author, yet no segment of the book seems to directly represent her own point of view. Odd though it may seem, the consistency of this approach contributes to the book’s readability.

Throughout the book, the authors refer to the literature that helped create modern psychiatry, much of it originating in the 19th Century. I’ll close with a story from that century about a young woman who had the mental condition known as anorexia nervosa, which is mostly a female syndrome, in which the patient refuses to eat. To give an example, he cites the story of Sarah Jacobs, who stopped eating normally as she entered puberty. I’ll close these comments with her story:

[Sarah] claimed to need no form of nourishment and became a tourist attraction, bringing her family money and fame. A medical team was sent to observe this apparent miracle, providing nurses to watch Sarah around the clock and ensure that she wasn’t surreptitiously given any food or water. After six days of this, Sarah was clearly failing, and the nurses appealed to the doctors on the team and to Sarah’s father to feed the girl. Mr. Jacobs refused, presumably determined that the family’s golden goose not be slaughtered, and after ten days of observation, Sarah died.

This book is powerful; I rank it a Canadian masterpiece. Every page is a source of knowledge and wisdom. It is worth savouring.

Monday, March 27, 2023

 The Upright Thinkers:

The Human Journey from Living in Trees to Understanding the Cosmos

By Leonard Mlodinow

Book Review by Peter McKenzie-Brown

Our last club meeting spurred me to finish reading this book and report on it. The reason is that I believe in science far more than religion. This book balances those ideas by presenting a magnificent commentary on the evolution of our understanding of planet Earth and beyond. 

A physicist with a PhD from U Cal Berkeley, Mlodinow is a terrific writer, with a style that ranges from delightful humour to serious commentary on political developments. But throughout this book he is a scientist first. Also, he’s Jewish, so not opposed to religion.

He demonstrates how scientific developments are not only the product of isolated genius, but depend on the convergence of systems, technologies, and happenstance. This book is a witty and thought-provoking account of the history of scientific discovery.

A subtext to this story is the story of Judaism over the years. Mlodinow comes from Jewish stock; the story of his father in a Nazi concentration camp appears in the first chapter, and he reappears throughout. Near the end, the author talks touchingly about his death.

A California Institute of Technology physicist and bestselling author, Mlodinow offers readers a grand history of science in this book. Spanning more than three million years, his account of how humans came to ask questions about the physical world and the meaning of their own existence is a powerful read about the development of scientific thought and process. His explanations are clear, even when they concern the most puzzling developments in quantum mechanics. In short, it is a concise and engaging introduction to the history of science and to history’s most important scientific developments.

Long overarching histories sometimes risk overlooking complexities, smoothing over contradictions and disputes. The Upright Thinkers embraces them, skillfully showing that the progress of science depends as much on happenstance, culture, and institutional backing as it does on the passion and persistence of its main cast of scientist characters. Although the book recounts the stories of already well-known figures in science, such as Galileo Galilei, Isaac Newton and Albert Einstein, their profiles offer rare glimpses into the social contexts of the scientists, their tribulations, and their shortcomings. The “vision of the great discoverers of intellectual history is more often muddled than clear, and their accomplishments more indebted to their friends and colleagues – and luck – than the legends show and than the discoverers themselves often wish to admit.”

For example, in the chapter on Newton, Mlodinow writes about the rigid class hierarchies at Cambridge, while highlighting Newton’s tendency to work alone. These aspects of a person’s life show that scientific developments do not occur at a stroke of genius. The story of the apple falling on Newton’s head is apocryphal; it took years of work and failure, along with coincidental meetings with other scientists and mathematicians, for Newton to develop his laws of motion. That said, Newton’s “progress required many hits on the head, and many years in which to process ideas and come to a true understanding of their potential.”

This book is full of characters with deep curiosity and an urge to understand how the physical world works. It is this curiosity that makes human beings distinct as a species. But incoherence and unpredictability constantly assault our capacity to ask questions and think. Beliefs and feelings animate science almost as much as mathematical or lab expertise. The author deftly illustrates this mishmash of ideas with personal anecdotes of his own encounters with physics and with physicists, some of whom would give the cranky Isaac Newton a run for his money in terms of temperament.

The author describes the ingenuity with which Heisenberg contributed to subatomic physics – first in the work he did in respect to the positioning of electrons around an atom; later by introducing the uncertainty principle, which added a lot to quantum theory. Although many of the key scientists behind nuclear physics in the 30s and 40s were Jews (Albert Einstein, for one), when Nazism took over Germany Heisenberg proclaimed that “Now we at least have order, an end is put to the unrest, and we have a strong hand governing Germany which will be to the good of Europe.” 

The Upright Thinkers pays detailed attention to the systems and technologies that played roles facilitating scientific developments. For Newton, it was the recent availability of paper that enabled him to scribble ideas into a notebook, which he called the ‘Waste Book’. This process was integral to his formulations of calculus. Charles Darwin  relied on the efficient ‘penny post’ system to share his ideas with colleagues to gather feedback for what eventually became On the Origin of Species, the first detailed account of natural selection.

This attention to the material contexts – such as the development of glass lenses, changes to the postal system or the availability of specific metals – that limited or enabled certain scientific developments makes for a nuanced account of how scientific thought progressed. It challenges a common view that science is a product of genius and hard work, while embracing the randomness through which discoveries are made. Alongside Newton, Heisenberg and Darwin stood friends and family members, stationery, academic gowns, religious institutions and communication systems, all of which played interesting and crucial roles in providing the environments in which scientists and innovators thought.

I found the last two chapters – titled, respectively, “Invisible Realm” and “The Quantum Revolution” – to be difficult reads. I attribute that to my limited background in hard science. But then came the epilogue, which speculates on what science may one day reveal about the cosmos. 

It almost left me breathless.