All reviews are by Dr. Lloyd Sederer

NEW TO THIS PAGE:

Book Review: The Guardians

Movie Review:  The Best Exotic Marigold Hotel

Book Review: Monday Mornings, by Dr. Sanjay Gupta

Book Review: Henry’s Demons

Book Review: The Azheimer’s Prevention Program

Movie Review: A Dangerous Method: notes on a film about Freud and Jung

Movie Review: Contagion – Scary Movie

Book Review: Heaven is for Real

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BOOK REVIEWS:

• Book Review: The Guardians
• Book Review:  Monday Mornings, by Dr. Sanjay Gupta

• Henry’s Demons: Living with Schizophrenia, A father and son’s story
• The Alzheimer’s Prevention Program
• The Bone Thief
• Outcome Measurement in Mental Health: Theory and Practice
• Heaven Is For Real
• KaBOOM! – How One Man Built a Movement to Save Play
• Nemesis
• Everything Ravaged, Everything Burned 
• The Naked Lady Who Stood on Her Head: A Psychiatrist’s Stories
• Healing the Broken Brain: Transforming America’s Failed Mental Health System
• Asylum
• The Garden of Lost Days
• Craving for Ecstasy
• Treating the “Untreatable”: Healing in the Realms of Madness
• The Unit

MOVIE REVIEWS:

• Movie Review:  The Best Exotic Marigold Hotel

• A Dangerous Method: notes on a film about Freud and Jung

• UNGUARDED – The High Life of Chris Herren

• Contagion: Scary Movie

• Buck: No Horsing Around
• The Dark World of Depression: Movie Review of The Beaver
• Limitless: Would the FDA approve?
• The Fighter: All in the Family
• The King’s Speech
• Winter’s Bone
• Adam
• The Blind Side
• Where The Wild Things Are
• Invictus

 

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BOOK  REVIEWS

The Guardians: by Sarah Manguso

Harris Wulfson died July 23, 2008. He had walked for some 10 hours from midtown in New York City to the Riverdale Metro-North train station (north of Manhattan), where he jumped before an oncoming train to his crushing death.

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Book Review: Monday Mornings

By Sanjay Gupta, MD – Grand Central Publishing, NY, 2012

When this book was released, as a great fan of Dr. Sanjay Gupta, I immediately marched down to my local Barnes and Noble and picked up a copy of his novel. Yes, a novel – not a medical guide book. 

For those unfamiliar with the ubiquitous Dr. Gupta, he is the CNN senior medical correspondent, a practicing neurosurgeon, and a frequent reporter on 60 Minutes and other network shows. He is a most affable doctor who dares to run marathons and live and eat right to model what he preaches. But a novelist? That is really pushing the scalpel, so to speak.

I was intrigued by the novel’s hook: as readers we would be taken into the closed door meetings that doctors have after a death (or near death) of a patient to review what happened and thereby to learn. These are called M & M Rounds; that stands for morbidity and mortality, and they are not sugar coated. As a practicing physician myself I have been to (and led) my share of M & M meetings; in my specialty, psychiatry, they usually take the form of “psychological autopsies” – when after the death (often by suicide) of a patient clinical staff meet to carefully review what happened and determine what could be done better to prevent another tragedy in the future.

“Monday Mornings”, the book’s title, are when the M & M conferences for surgery occur at the unforgiving hour of 6 AM in the remarkable Chelsea Hospital (chose which great hospital you think this may be) where doctors are heroes, ambitious and driven to be #1, kindly or unforgiving jerks, and (over time) revealed to be drawn from the same “crooked timber of humanity” that we all are.

Gupta, with his writing partner David Martin (whom he generously acknowledges), gives us both a medical tale and a moral tale. The medical tale is about surgeons and ER doctors, primarily, whose astounding feats of diagnostic acumen and extraordinary operative and emergency interventions seem to occur far more often than the usual doldrums that I have seen characterize hospital routines. Gupta’s fictional neurosurgeons and ER jocks practice medicine on a thin tight rope that no one can repeatedly cross without falling off. In other words, there is no shortage of dramatic cases gone awry to summon the bleary doctors to face the unsparing critique of their peers before dawn on Monday mornings. Upon reading what goes on at Chelsea Hospital (where doctors, we are told, are apt to forgo great earnings to be great) , you may wonder whose hands you will be in if you hit your head, have a stroke, or enter an ER in some grave medical state.

The M & M conferences are depicted with blunt narrative force. Surgeons’ heads are (figuratively) cracked open by the pointed inquiries of the chief of neurosurgery and other daunting white-coated legends, egos are deflated, and lessons burned into the cortices of all those attending. I thought that the careful dissection of what happened and why that typifies a serious psychological autopsy – also to prevent a future deadly outcome – seems far less bloody than what happens in surgery, or at least in Gupta’s surgical circles. Is one approach better than the other to get doctors to pay attention and do better next time?

The book’s moral tale is no less forceful. Like Icarus, full of hubris, these physicians fly too high and too close to the sun’s searing rays. Down is the only direction when that happens. There was a great deal of human carnage by the end of the novel, with no major protagonist spared as I took the body count. Grief darkened so many doctors’ doorsteps – ushered in by events at times seemingly just, at times deeply unjust or sometimes by life’s indifference to it all. 

What saved the book for me were the few tales of human transformation catalyzed by these unwelcome occasions of error and loss.  These were the stories that left me feeling that the greatest medical miracle of all is human resilience.

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Book Review: Henry’s Demons: Living with Schizophrenia, a father and son’s story

By Patrick Cockburn and Henry Cockburn

Scribner, NY, London, 2011

Remember Pete Earley’s book, Crazy: A father’s search through America’s mental health madness? Earley, a former Washington Post journalist, tells the story of his son who suffers with a psychotic illness and the madness of America’s mental health (and correctional) system. Nothing quite like having a top-notch professional journalist on a mission to tell a compelling story. Well, now we have another fine journalist from across the Atlantic bringing us into the world of mental illness, family, community and the mental health system in the United Kingdom in Henry’s Demons.

Henry’s Demons tells, through alternating father and son chapters , the story of Henry Cockburn’s descent into and slow emergence from a serious mental illness. His father, Patrick, is an accomplished war reporter for the Financial Times and The Independent whose life is forever changed by his son’s mental illness; he writes the predominance of the book. Henry was the first of two boys in the Cockburn family, where mother was a college professor who cared for the boys and father was usually gone to far off and dangerous war zones; Henry was a creative boy who never quite fit in and who smoked a lot of marijuana as a teenager (too much he remarks).

Through father and son we enter the world of mental illness in personal and painful ways. But memoirs are now common and suffering often their métier. What distinguishes this book are the plethora of lessons learned, none delivered in didactic or pedantic ways but instead through story and experience. Herein lies why I would suggest this book to families and mental health practitioners.

Among these lessons are:

-          How what we so often see as denial (‘nothing the matter with me’) is a means by which a person defends their identity and grasps to maintain the integrity of their very being

-          That moments of lucidity in people with mental illness where they see the gravity of their illness and its consequences on their lives may be impossible to endure

-          That mental illness can induce a state of idiosyncratic narcissism in those affected where concern about the impact of their illness on their families and others seems to vanish into the air

-          How marijuana and other mind-altering drugs erode what little protection to mental illness a constitutionally vulnerable person may have

-          How families can be seduced into unaffordable financial investments to care for their loved one when, in fact, the care they buy is often no better, and many times worse, than what a good public sector service system can provide

-          That families that open up with others about their struggle discover that they are not alone, which can be essential to staying supportive to a loved one with a mental illness for a lifetime

-          That intramuscular administration of antipsychotics for some people who will not take oral medications may be the only way to build a foundation of sanity, on which critical psychosocial interventions can occur

-          Clozapine, which is proven to work better for treatment resistant schizophrenia, is really underutilized

-          That we have yet to establish the community equivalent of the asylums of the 1800s where people with serious mental illness can have safe and supportive communities in which to do the work of recovery

Patrick is a keen observer of the limits of mental healthcare and the profound turmoil that mental illness produces in those closest to the person who is ill.  His journey began thinking that schizophrenia was a disease to be cured and he evolved to understanding it is a disorder that can be controlled and need not drive a person to states of bizarre and dangerous behaviors and a life fated to be without love or work.  Henry tells his story with seeming naiveté and remarkable vividness still half believing the varied delusions, hallucinations and psychotic views of the world he experienced. But he does so from a growing state of recovery in which he can understand what unhinges him (like smoking pot and not taking medications) and what he needs to do to contend with his psychosis.

As the book ends, both father and son have achieved a sense of growing optimism that their lives, while irrevocably altered,   can be rebuilt in ways that they have yet to quite understand. 

Originally published in the American Journal of Psychiatry, January 2012. 

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The Alzheimer’s Prevention Program

Dr. Gary Small and Gigi Vorgan — Workman Publishing, NY, 2011

 Remember these 8 words: bus, screwdriver, mango, playground, swallow, sun, couch, and rectangle.

Wait a few minutes. How many can you recall?

How many words of three letters or more can you make from the following scrambled letters: A E L S K

How many did you create? There are 18.

How many times this past week did you struggle to remember a name? Or forget where you put something?

Just about everyone has some loss of memory as the decades collect. Don’t confuse normal aging with Alzheimer’s. But some people as they enter their 50s and 60s experience what is called “mild cognitive impairment (MCI)”. They are often forgetful, can become a bit confused and display other symptoms suggestive of mild Alzheimer’s – but they can manage. However, MCI heralds a far greater likelihood of developing AD, as great as 15 times more risk. Some regard MCI as a transition to AD. 

Alzheimer’s Disease (AD) is the demon of older age. A small percentage of people (5%) will fall ill to its neurological destruction before the age of 65. But as we age into the seventies, eighties and beyond the numbers affected grow substantially. Today, every 70 seconds a person in the USA develops AD; estimates are that this rate will rise to every 30 seconds by 2050 as we all live longer. Not all dementia is due to Alzheimers: vascular dementia (due to blood vessel narrowing or stroke in the brain) accounts for perhaps 40% of severe memory problems (and other symptoms). But AD is the greatest threat to our memory – and even more so to our very sense of identity as we grow old.

While there is a genetic risk to developing Alzheimer’s (1 in 5 people carry the gene type APOE-4 that increases the risk of AD), having the risk does not mean you will get the disease. In fact, most experts do not recommend that patients get genetic testing to determine if they have this gene type. Instead, sound advice centers on what we can do to prevent, delay and reduce the impact of AD. In fact, what can be done is principally under our control: It is in how we lead our lives.

Feeling like you need to do something? Well, the prescription is quite clear, useful and even feasible. Enter Dr. Gary Small and his co-author (and spouse) Gigi Vorgan. Dr. Small is an internationally renowned expert on aging and dementias; he is a Professor and director of the UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior. Ms. Vorgan is a professional writer and producer for film and television. Their collaborations have produced books as varied as The Memory Bible (a NYT bestseller) and a collection of short stories called The Naked Lady Who Stood On Her Head (http://www.huffingtonpost.com/lloyd-i-sederer-md/the-naked-lady-who-stood-_b_786553.html).

In this new book on Alzheimer’s prevention, they clearly lay out a plan to prevent, delay and diminish the symptoms of AD for those who are at risk, which is most of us if we live long enough. The writing is personable, funny, and helpful. The book is full of puzzles, informational charts and exercises (body and mind). The actions you can take are entirely feasible:

Try reading a few sentences of this article upside down (except on an iPad which will defy you).

Try their memory training regimen, which they call “look, snap and connect.” I did, it works.

Stand on one leg, close your eyes and count backward from 100 by 7s.

These are but a few types of brain exercises: there are many, from crosswords, to learning a new language, to trying to beat someone in Scrabble. You can discover how memory wizards recall the random order of a shuffled deck of 52 cards. You can complement brain training with walking more; socializing more; eating more fish, olive oil, and nuts; managing your stress and reducing the body’s inflammatory response; even have a glass of wine. You can use food supplements, meditation and perhaps medications.

You may be asking, who has time for this? But self-care, self-management, is the secret to managing every form of chronic disease – including cardiovascular disease, diabetes, depression and PTSD, asthma, emphysema and other lung conditions, Parkinson’s disease, low back pain and a myriad of arthritic conditions, and cancers of all sorts. The question may not be who has time but rather who can escape self-care and expect to function well and have a good quality of life?

As a rule, I am not much for self-help books. But this one is more than self-help. It is more like having an expert coach teach you about aging, memory and neurological diseases and then instruct you about how to do what is in your control to maximize your brain functioning as you age. Each part of their plan is beneficial – nutrition, exercise, stress reduction, brain training, and having people in your life all make a difference. And each one complements the other. So, if you only do a few, you are better off with each element of their plan that you incorporate into your life. Not only that, as you build these healthy actions into your life you are going to help all the other things that ail you. Now that’s worth doing.

Hmmm, now what were those eight words?

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Originally published in the Huffington Post/AOL on January 11, 2012 

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The Bone Thief

Jefferson Bass (writing team of Jon Jefferson and Dr. Bill Bass), William Morrow, New York, 2010

Bill Brockton, PhD, the protagonist of this novel, is a tortured soul. But he’s not that interesting. However, his field is. Want to find hitherto lost or hidden dead bodies? Want to know when and how they met their maker? Then you need a forensic anthropologist, not just the police. And that science has blossomed thanks especially to the work of Dr. Bill Bass, whose research facility at the University of Tennessee, affectionately called The Body Farm, has studied body decomposition for thirty years.

This fifth novel is about the innocent dead and the sociopathic living – and the Body Farm. It derives from the ongoing collaboration of Dr. Bass with Jon Jefferson, a journalist and documentary filmmaker. Their work has been best seller stuff, and it keeps coming.

In this tale, we encounter Dr. Bill Brockton (Dr. Bill Bass’ fictional avatar) after his wife dies. As if that were not enough, his first love as a widower is murdered and he is (falsely) accused of killing her, which didn’t do a lot for his mood or career. After dusting himself off once again, he has a one night stand with a librarian who then kills another scientist and maims a close friend and colleague – only to discover she is on the lamb and apparently pregnant with his child.

The main story, intertwined with that of our struggling hero, has to do with the black market in body parts. Actually an important story if you need a kidney or a cornea or a hand (1). But Jefferson Bass’ (sic) story of grave robbing, murder, extortion, an FBI sting, even University politics, left me flat. There were some good chase scenes but it all was too pat, with an ‘all’s well that ends well’ conclusion that stretched too many mental ligaments, so to speak.

I went back to the Stieg Larson’s trilogy about the Girl with the Dragon Tattoo to see what I was missing. It is truly intriguing characters, nail biting suspense, meticulous plot and stupendous pace.

 The “Bone Farm” books have developed an audience and perhaps that is you. But if you can rarely get to a work of fiction you may want let these Bone Farm books rot and use what precious time you have left above ground to read something else.

 (1)   Satel, Sally: Desperately Seeking a Kidney, The New York Times Magazine, Sunday, December 16, 2007

Initially published in the Journal of Psychiatric Services, December, 2011.

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Outcome Measurement in Mental Health: Theory and Practice

Edited by Tom Trauer

Cambridge University Press, 2010, 266 pages, $95

We can derive a number of necessary lessons from this well-crafted, scholarly and internationally oriented text. First, by examining mental health assessment in the UK, Europe, Australia and New Zealand, even a glimpse at the USA, we see a reassuring picture of how responsible academics, clinicians and governments are trying to show that their mental health programs work and are worth the money. There is even significant agreement among domains to focus upon and measure. The book is an around the world tour of mental health measurement in fewer than 300 pages. Your journey takes you through three well edited sections on Outcome Measurement Around the World; Outcome Measurement in Specific Groups and Settings; and Current Issues in Outcome Measurement.

Second, and here there is no cause to break out the champagne, measuring clinical and functional outcomes, provision of services, experiences of care, even recovery, does not equate with improving the very same. Not that the two are typically and inextricably linked, but they need to be. The adage “what gets measured gets managed” does not seem to apply in so many of the countries, local government programs and service sites the editor and authors amply and ably portray. It’s not their fault, they are reporting the facts.

Third, and while only implied in this book, the disturbing reality is that we in mental health (and the addictions) have two vast and fundamental problems: 1) people with serious mental illnesses don’t seem very often to want what we have to offer, demonstrating this by their lowly rates of engagement and retention in care; and 2) for those who actually engage, in most countries and in general medical as well as specialty mental health settings, the likelihood that recipients will have their conditions routinely screened for, properly diagnosed and effectively treated is woeful (the science to practice gap in the USA reveals that less than 20% of people in need get anything akin to “minimally adequate care.”) Oy.

Measuring outcomes is a necessary element in trying to change the unacceptable way things are today. But measurement is far from sufficient. We are bereft of accountable organizations that accept and meet the demanding responsibilities of serving people with serious mental illness – typically also having drug/alcohol abuse and chronic medical disorders (like cardiovascular disease and diabetes that strip quality from their lives) – in a manner that is focused on what they want in life. We lack payment systems that reward the right things, what consumers and their families seek, rather than paying, as many do, for what is done and worse, for doing what is not working. We still are too timid about explicitly declaring what effective treatment must be – at least if a clinic license is granted or payment made from government or insurers for what is done.

The concepts, methods and tools provided in this concise book will surely come in handy when we have systems of care that can effectively use them.

Originally Published in The Journal of Psychiatric Practice, November 2011

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Heaven is For Real

By Todd Burpo & Lynn Vincent, Thomas Nelson, 2010

Because I believe in some sort of hereafter I couldn’t help myself. I downloaded “Heaven is for Real” onto my iPad before I left for holiday  in a small town in rural France along one of its historic pilgrimage trails (see Journey for Body and Soul: The St. Jacques de Compostelle Pilgrimage Trail, http://www.huffingtonpost.com/lloyd-i-sederer-md/journey-for-body-and-soul_b_666756.html). What better place to read about adventures with the next world, I thought.

The book, written by Todd Burpo, a Nebraskan minister, and Lynn Vincent (it is not common for a ghost writer to be identified and if so it is maybe ‘with’, not ‘and’ – though she also did Sarah Palin’s Going Rogue), is an easy read: short, simple, childlike in its prose and delivery. For those who may not have heard of this book sensation, topping the New York Times non-fiction list and sparking worldwide notice, the story goes as follows.

Colton Burpo, the second of two children in the Burpo family of Imperial, Nebraska (population ~ 1800), becomes gravely ill from an undiagnosed ruptured appendix while on a family trip in the early spring of 2003. The family was having financial problems from medical bills after dad broke his leg, had kidney stones, required a mastectomy for suspicious cells (while rare, men do get breast cancer), and could hardly tend to his business. This was their first time away in some time.

Colton was almost four years old when he goes to heaven (and returns). His dad is the pastor of the Wesleyan Church in Imperial, and also a volunteer fire fighter, high school wrestling coach, and owner of an industrial garage door company to supplement the limited wages of a small town clergyman. His mom, Sonja, today with three children, is a “busy mom” as well as a certified teacher, active as a pastor’s wife, and runs the operations of the garage door company. Cassie, the older sister, appears to endure all this activity with good humor, including her brother’s trip to heaven and ongoing reports upon his return.

Their trip, in March 2003, was cut short because Colton required an emergency operation for a ruptured appendix which was complicated by days of abdominal infection, including an abscess that required post-operative draining. Colton, unbeknownst I gather to the surgical team, took a “three minute” trip to heaven and back during surgery. He did not leave the operating table nor reportedly cease breathing or experience cardiac arrest. In July of that same year, then fully recovered and four years old, Colton delivers his first account, on another family trip, of his adventures in heaven, which by the way is for real according to the “astounding story of his trip to heaven and back” (the book’s subtitle).

I read every page of this book, and every piece of reported evidence that he must have been to heaven. The book’s popularity is a window into its readers and our culture. What does it convey that explains how avidly it has been consumed? What does it say about our world?

Colton’s story is a fabulous one, full of sweetness and innocence. He is the child of a deeply religious family where prayer is a staple in their lives. When he begins to report that Jesus was at the right hand of God, who had a massive throne, the authors say he “could never know {that}” yet go on to describe daily bedtime bible stories and routinely traveling with his father as he serves his religious community. Colton tells his dad that the angels have wings, but he had little wings. Wings are needed because “we flew” – all except Jesus who “went up and down like an elevator.” Jesus’ eyes were “so pretty” and he wore purple. No one else wore purple, according to Colton; the others wore white, with various color sashes. Jesus had a crown too and “markers” on him (red spots meant to signify stigmata). Colton later reported that Jesus has a cousin (must be John the Baptist) who is “really nice”, and a horse. There are lions in heaven but they are not dangerous. And he tells his father of a battle to end all battles, with swords and bows and arrows, yet to fear not, even though you (dad) will be in that battle (and thus in heaven) because the “good guys” win. Colton also tells how he met his sister, unborn from an early miscarriage, while on his trip to heaven, though we are told his parents never told him about the miscarriage, as well as his dad’s uncle “Pops” who died at 61 but appeared as a man in his 20s, since “no one is old in heaven”.  Burpo reports that Colton did not know about “Pops” although his photo stands on Burpo’s desk.  He tells his dad he saw him in “a little room by yourself praying, and Mommy was in another room and she was praying and talking on the phone” when he was in surgery. And they were. There are other examples, but you get the picture.

All this comes out in bits and pieces over months, and then years, each time apparently eliciting awe and reinforcement from his parents.

Colton must be one remarkable boy, deeply attuned to his family and their spiritual environment. His is an American family who despite misfortune and testing emerge on the side of light not darkness. They pray and their prayers are heard. Their community responds in their time of need.  Fellow travelers share their hardship and are buoyed by the Burpos. It is a welcome anodyne to the harshness we see too much of every day, the bad news media we tune into and the tales of selfishness and division that fill our ears. Thank God for Colton Burpo.

As for Lynn Vincent and her franchise on telling blockbuster stories, spiritual and political: what will she co-author next?

I have no quarrel with the success of this book. It has touched the hearts of many people. But it asks us to suspend our critical thinking. That is what faith is about. Faith may be helped along by examples of wondrous events, as was this boy’s survival, but not by fantastic stories with less than credible evidence. Had Colton’s tale been called a fable then maybe I could have believed.

Originally published in the Religion Section of the AOL/Huffington Post on July, 11, 2011.

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From Mission to Movement: KaBOOM! and the renaissance of play in America

Book Review of: KaBOOM! – How One Man Built a Movement to Save Play, by Darell Hammond, Rodale Press, 2011

Darell Hammond was born almost 200 years after the man who must have been his past life embodiment, Johnny Appleseed. Appleseed introduced apple trees in large sections of the Midwest as America, in its infancy, entered the 1800s. His legend quickly spread for his role in seeding apple nurseries, lush in symbolism, as well as stories of his remarkable selfless and generous persona. Fast forward to the 1990s when another man of humble origins and indefatigable spirit, Darell Hammond, was moved to provide children with the generative experience of play that had been evaporating from American cities.

Over the past 15 years, Hammond and his band of modern, secular missionaries have built 2000 (!) playgrounds in this United States through KaBOOM! the organization he founded. What’s more, his methods – open source – account for 40% of the all the playgrounds now built across the country using local volunteers and instructions downloaded from KaBOOM!’s website (www.kaboom.org).

Hammond began KaBOOM! with an innovative method in which communities not only create a play space for their children but also experience the satisfaction of knowing it was their community of children and adults who built the playground. That is what he means when he says that KaBOOM! “facilitates transformation… not just transaction.”

Hammond’s first playground rose out of the ashes of a horrific tragedy. He had moved to Washington DC and was planning a playground at a desolate inner city housing project when the Washington Post carried a story of the death of two children, four and two, who went to play in a parked car, were locked inside, and died of the heat and suffocation. The Post called the story “No Place to Play.” The mission of KaBOOM! was thus born: “…a great place to play within walking distance of every child in America.” Hammond himself was raised in a foster care setting outside of Chicago after his father abandoned the family leaving his mother to raise eight children. Yet his attitude, as is so sweetly depicted in this memoir’s tale of personal and societal striving, is not one of ‘pity me’ but instead of a duty to serve, and serve he has.

For those unfamiliar with KaBOOM! let me offer a few details. The process starts with a community wanting to create a playground (not with KaBOOM! arriving and saying we have something for you). The impetus thus derives from a community, which then has to mobilize partners and generate resources (a playground typically costs $75,000, which is affordable to even highly depressed areas through methods they are coached in). Then comes “Design Day” where local children draw their ideas of the playground they want to play in and neighborhood residents plan it for their community. Within 12 weeks “Build Day” arrives – where in 6 hours the playground is constructed. Hard to believe, but since it has been done 2000 times you gotta believe. Amazingly, 86% of the playgrounds they have built have been maintained in the years that follow, a testimonial to the process of having communities create, construct and then ‘own’ what they have done. If you want know more, do read the book.

In the early years, KaBOOMers organized the playground builds themselves, but soon realized that building playgrounds at the pace of 200 a year or even multiples of that would not realize their aim of a playground in reach of all children. That is when their mission began to evolve into a movement. Inspired by, of all things, a wedding planning website (which he and his now wife turned to) Hammond realized you can systematically plan for a playground just like a wedding. Over recent years, KaBOOM! has provided open source information about how to build playgrounds and estimates that for every playground they build ten (10) more are done by following their on-line instructions. Even more recently, learning from children about the value of unstructured play, they have developed a ‘Playground in a Box’, a giant toy box that combined with water and sand become the ingredients for opening a playground just about anywhere. Their playgrounds are now ever more diverse and their projects have included nature and skateboard parks. Their company, a not-for-profit, remains fresh with the creative power of play driving their work.

Hammond is a genial man, without pretensions, who will wear a sport coat to a fundraiser but clearly would rather be in work clothes building and playing with children. This memoir shows how one person after another ‘adopts’ him, mentors him, and becomes a part of the mission themselves. These fellow travelers include the Director General of Moose International which fully funds Hammond’s foster care home, community development gurus, Marion Wright Edelman, and corporate titans. Hillary Clinton, Al Gore, Colin Powell, Laura Bush and Michelle Obama have all joined his cause, and have participated in KaBOOM! Build Days. What I see is that Hammond draws great people to him because of who he is and the magic of the movement he has created. Play is not an incidental activity: it is seminal in the lives of children and the health of communities.  Hammond is a modern day Johnny Appleseed out to plant the seeds of play within reach of every child in America.

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It’s not the illness that stands to destroy you: Thoughts after reading Philip Roth’s latest book, Nemesis

It was the summer of 1944 and with the world at war America’s youth were not only endangered by the pitch of battle in Europe and the Pacific. A polio epidemic had erupted and was taking lives and crippling those, especially children, living in the United States.

Philip Roth, Pulitzer prize novelist, takes us into the everyday lives of the families, Jewish families as he is wont to do, of Newark, New Jersey. The story revolves around Bucky Cantor, a 24 year old phys-ed teacher and playground director, the boys at the Chancellor Street playground, and Bucky’s girlfriend, Marcia Steinberg, and her family. Bucky has come of age thanks to his grandparents since his mother died at childbirth and his father had been a crook. He is rejected by the draft because he is terribly myopic but otherwise he is an exceptionally healthy and decent young man, a high board diver, javelin thrower and weight lifter, whom the boys in the neighborhood and playground adore.

A sweltering heat wave hits Newark. But that becomes the least of its troubles. Silently, the polio virus enters and child by child strikes, indifferent to the suffering and anguish it will cause. Some survive, spared respiratory paralysis by what were called iron lungs, but are disabled for life, and some die. The virus does not have any rules about who deserves what fate. Readers of this book will share the pain because of how extraordinary a writer Roth is and the beauty of his prose makes the heartbreak all the more.

Bucky first is witness to the illness and its ravages in his playground boys. Then he is witness to the disease in the Pocono camp he retreats to in order to escape Newark, stay alive and be with his beloved Marcia. How did the virus concentrate among his boys, and then the camp, which had been spared? Was he the carrier? Then Bucky gets polio too. After near to two years of hospitalization and rehabilitation he is left with the limitations of one functioning arm and leg and a bitterness that is limitless. His ‘noble’ act is to spurn Marcia who remains in love and dedicated to him. After all, he says to himself, he is crippled, probably infected her baby sister with polio, and is no longer the man that she and her family deserve. She tries, her father, Dr. Steinberg, tries, but Bucky is resolute. His punishment is to deny himself forever of what sustenance life can provide, even when disease robs us.

Some 30 years later, Bucky is alone, a desk postal worker, living in another Jersey city with a life as bleak as he can make it, when one of the playground boys, now a man himself, Arnold Mesnikoff, spots him walking down the street. Mesnikoff too contracted polio during that awful summer; he too spent endless months in rehabilitation. But slowly, step by step, literally and figuratively, he rebuilt his body and his life, found a woman who loved and admired him, polio disabled as he was, became an architect who specialized in converting homes for people in wheelchairs, and had two children. They develop a friendship, and meet weekly for lunch at a local diner.

We thus meet two men: one a shell of his former vital self, embittered, enraged with God, and alien from his community; another who has suffered, because no person so disabled escapes the persistent physical pains the condition produces nor the emotional coming to grips with his limitations through every stage of adult life, yet finds a way to have love and purpose in his life. Roth shows us how Bucky had every reason to rail – to see himself as the pestilence itself and to see the evil in the world, whether in the form of polio or the Nazis. Yet, did Bucky have to debase himself and self-destruct his arc as explosively as he did? Was there no way for a life? Did he have to be ‘so against himself’ in a world that already has such an abundance of suffering for all to endure?

I thought, it was the polio that made him sick but it was his character that destroyed him.

Originally published on  January 18, 2011, in the Huffington Post

http://www.huffingtonpost.com/lloyd-i-sederer-md/its-not-the-illness-that-_b_809729.html 

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Everything Ravaged, Everything Burned

By: Wells Tower  – Farrar, Strauss and Giroux

This review first appeared in the Journal of Psychiatric Services  (Volume 61, December 2010)

This is a book about men – and boys – though there is one story that is not. Maybe only men will be interested in reading these marvelous, irresistible though dismal tales of hapless, endearing losers.

After consuming several I wondered how can these men, one after another drawn by the author so thoroughly in so few words, take it? How can they bear the defeats, the losses, the ignominy, the loneliness, the sheer misery that has befallen them, in good part at their own making? How can we, the readers, bear their tortured tales?

Yet I found myself moving from story to story, like rappelling from one jagged rock face to another, motioned onward by the flight of Tower’s imagination and masterful wordsmithing. His writing is lucid, salty, ironic, loving and mocking, and at times downright weird. And the story lines are so unpleasant as our heros go from bad to no better or worse, with an occasional resurrection that took me by surprise.

We begin Tower’s journey with “Brown Coast”, not blue or red or even green. A down and outer meets some locals and a life that was on a string becomes more frayed. Yet the hero makes a point of saving the creature that destroys what he has tried to rebuild. We go on to meet two squabbling brothers in “Retreat” – I think suggesting what men do when they are being vanquished by the enemy. The “Leopard” is brilliant and tight and opens a window into the seemingly incomprehensible mysteries of pre-adolescent boys. “Door in Your Eye” waters our evaporating hopes for men who have given up, but only sparingly so.  If you want drifters, grifters and boys and men who hit every pothole take a look at “On the Show”.

The last story, the book’s namesake, seems to come out of nowhere. We meet tribal Scandanavians from some indefinite past looking for a fight to rid them of their ennui, before anyone knew what that was. The pages of this story are barbaric with scenes that reveal just how cruel and foolhardy men can be, for no good reason. This story uses the phantasmagorical to remind us of the timelessness and absurdity of violence and war.

Want a trip down loser’s lane? Want some striking writing? Want stories that hang together because men are such a reliable source of material? Well then, go get ravaged and burned by Wells Tower.

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The Naked Lady Who Stood On Her Head: A psychiatrist’s stories of his most bizarre cases 

Gary Small and Gigi Vorgan

William Morris/Harper Collins, 2010

Dr. Gary Small began his prominent career as a resident in psychiatry at the Massachusetts General Hospital (MGH), in Boston, Massachusetts. His collection of stories also begins at this illustrious hospital and then traces the arc of his career – with the last story one where he the child has now become father to the man.

In full disclosure, I was at the MGH as the inpatient psychiatry director when Dr. Small arrived, though he did not rotate on my service. But I recall meeting him and getting to know him through his training years. He had the same qualities of warmth, lucidity, humor, intelligence and humility that come through in his stories. The tales he tells create an intimacy with him, what psychiatrists do and our manner of practice, and even a window into his marriage and parenting (in other words, it is all so human), with his wife and co-author Gigi Vorgan. But it is Dr. Small’s ability to instruct with clarity and brevity that has keenly developed over the years that gives the book its unique value.

Our journey into the world of psychiatry begins with the tumultuous story of working with someone with a borderline personality: young Dr. Small is soon over his head with problems caring for his patient, aggravated by bad supervision. We move on to the “Naked Lady Who Stood On Her Head”, the book’s namesake, where he delivers a quick emergency cure to a young woman delirious from severe hypoglycemia; but he also has the sense to not stop there and continues to work with her and her family so she can move beyond dependence and self-neglect, which is what will keep her out of the ER in the future. “Fainting Schoolgirls”, an account of mass hysteria among students in a Boston suburban school, put our author on the professional map while still a resident and is a great tale of mystery, hubris and public (mental) health. Other stories uncover how our minds can take control over our bodies with phenomena as seemingly ‘bizarre’ as false pregnancy, catatonia with mutism, and hysterical blindness. Still other stories have Dr. Small unlocking family puzzles that are creating psychic pain and familial dysfunction. The last story, of fifteen in all, has him today as the world renowned geriatrician he has become taking on the care of his mentor who turns to him to be his doctor. Dr. Small has gone from student to master of his craft but with the right amount of self-doubt and self-examination to help ensure that he will do right by his patients, no matter who they are.

This collection is a primer on psychiatry. It benefits tremendously from Dr. Small’s approach, which is a blend of biological, psychodynamic and family treatments. He was well schooled and as his career progressed he did not cloister himself in biology – even as his principal research focused on the brain and Alzheimer’s disease. While some of the stories seem too neat or quick to resolve, unlike my experience of how messy or extended our work often can be, he adds, sotto voce, that his treatments tended to continue for some time.

This is a book whose stories thoughtfully depict essential aspects of mental health treatment. Few people actually understand, and thus tend to mischaracterize or stigmatize, what goes on in a psychiatrist’s office: for good reason, since it can be hard to explain. Stories have always been a wonderful way to illuminate the unknown or seemingly inexplicable. The “Naked Lady Who Stood On Her Head” had the good fortune to have had Dr. Gary Small cure her. Many patients, and their families, will be helped to enter and remain in mental health treatment by his and Ms. Vorgan’s lively and revealing storytelling, which will be almost as good as seeing the good doctor himself.

Originally published in the Huffington Post on November 21, 2010

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Healing the Broken Brain: Transforming America’s Failed Mental Health System

by Timothy A Kelly. New York, New York University Press, 2009

I had hoped for more from this book, with its evocative and expansive titles. Timothy Kelly, a psychologist by training, was Commissioner of Virginia’s Department of Mental Health, Mental Retardation and Substance Abuse Services for several years in the mid-1990s and then went on to different leadership roles in mental health in this country.

In this short book, Kelly’s proposition is that the mental health system is broken (with proper attribution to the President’s New Freedom Commission), that incremental change will only sustain what we have (maybe better to say what we don’t have), and that transformation driven by a “perfect storm” of economic necessity and public outcry is what we must hope for. He calls for evidence-based practices, measuring performance, competition, consumerism, and leadership. He is clear in his overarching analysis and goals but does not take us far enough into the mess of it all where transformative solutions must be found, supported, and brought to scale.

What would it take to transform our failed system? This is a question I began to try to answer recently in a commentary for another journal (1). Perhaps the answer is best understood, especially by clinicians and policy makers, as the gap between what we know and what we do—a gap so wide it continues to astound. But I believe that a fine model for closing the gap is a public health one: identify the populations and diseases where prevalence and burden are great, where solutions (often good if imperfect) exist, where those solutions (treatments and social interventions) are known but not being sufficiently employed, and then systematically proceed to implement those solutions—person by person, disorder by disorder, community by community,  and population by population until we can be assured, by reliable and valid measures, that the gap is closing.

The means to close the quality gap, it seems to me, align along three complementary lines. These are the tools needed to close the gap, the actions needed, and the people or actors who will do so. The field of mental health (including substance abuse) can take pride in the array of tools we have developed. These now include clinical decision trees built from accumulated evidence (also called evidence-based and consensus practices); standards of care; drug utilization review that is truly directed to safety and effectiveness, not solely cost control; professional learning and quality improvement communities; professional distance learning (if you can get a master’s in business administration online, you can sharpen your clinical skills online); and peer coaches and supports along with “shared decision making” between clinicians and recipients.

The actions are how these tools are used. Here are some ways: contracting by buyers (government and industry) that specifies the results expected of what is bought; performance monitoring where what is bought is measured and monitored; financing of services increasingly on the basis of what works and how good the delivery is; accreditation and licensing of services (clinics and hospitals) dependent on clinical performance, not exit signs, square feet, and door hinges; and regulatory relief as well as regulatory change consistent with the clinical objectives needed.

But nothing happens unless we humans drive it. The actors are government—progressive government, which needs to lead—especially at the state level, where Medicaid drives health care practices and policy. At the federal level, we have a unique moment for interagency collaboration among the Centers for Medicare and Medicaid Services, Veterans Affairs, and Housing and Urban Development;  perhaps the Substance Abuse and Mental Health Services Administration will have a voice, not just a seat at the table. The clinical community, providers, needs to examine itself and be dissatisfied with what it’s doing since our results are so far from what they need to be. This is not to blame providers since they are at the mercy of the “non-system” we have grown and the peculiarities of financing – but clinicians and clinical administrators need to be restive about what we are not doing. Perhaps the most important actors will be consumers and their families who organize to assert their will and refuse to allow the status quo to persist since hope and a life of contribution in the community is possible for people with serious mental illness, if we do the right things.

That’s a lot of tumblers that would need to fall into place to open the lock(s) keeping us from transformation. Yet it was not long ago that schizophrenia was considered a hopeless condition. Why should we have the same dismal regard for transformation? Problems are there for solving, not for acceding to. Like John F. Kennedy said, we do it because it is hard, not because it is easy.

Reference

1 Sederer LI: Science to practice: making what we know what we actually do. Schizophrenia Bulletin  2009; 35:714–718

This review appeared in the June 2010 issue of the American Journal of Psychiatry  

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Asylum: Inside the Closed World of State Mental Hospitals

Photos by Christopher Payne

Essay by Oliver Sacks

MIT Press, 2009

August buildings and noble aspirations exemplified the Moral Therapy era of the early 1800s. Mental institutions in this country, Europe and the UK offered asylum, in the best sense of the word, and purposeful activity for people with mental illnesses. Notably, these asylums worked, giving us the forme fruste of what now we call the “recovery movement”.

In his book, Asylums, Christopher Payne hauntingly portrays the decaying bones of the skeletons of these formerly vigorous embodiments of western psychiatry and mental health. Never having visited a mental hospital before he set off on this remarkable project.

Payne writes “… a friend…told me about Pilgrim State, the largest facility of its kind when…built in the 1930s…I drove there and was immediately astounded by it size and dumbfounded by its desolation.” Pilgrim State, at its peak, had near to 15,000 patients, essentially a city of its own. In fact, a mere 50 years ago New York State had over 90,000 people in its state mental hospitals; today we have 4800 – though OMH has almost twice as many – 8500 – “outpatients” in 31 state prisons – institutions that now house too many people who need to be residing someplace else.

The New York State Office of Mental Health has 26 psychiatric hospitals and they are well represented in Mr. Payne’s book. One OMH facility, twice depicted in his book, actually has more buildings than inpatients.

I suppose we could consider the dramatic reduction in New York (or other) state psychiatric hospitals’ census a great success had two things been achieved:

-         First, would be if states had realized a true system of community care where accountable, responsive, and quality recipient and family centered care was the norm, rather than a too infrequent even surprising experience.

-         Second, would be if state mental hospital buildings and their often elegantly landscaped campuses were repurposed – by which I mean they had been restored and revitalized, where these historic buildings and their precious land had become markets, mixed use affordable housing for low income essential workers, seniors and people with disabilities, parks, and entertainment sites that brought life and livelihood to their communities.

Instead, Mr. Payne’s photos, brilliant as they are, poignantly indict the social forces that have left these remarkable sites abandoned. The desolation of the images he presents mirrors the bankruptcy of our behavior to those who perennially become ill with a mental disorder and whom we know can do better — if provided a life with – housing – and community – and opportunities for love and work.

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The Garden of Last Days

Andre Dubus III

Norton, NY 2008

Previously published in the Journal of Psychiatric Services

The French have an expression for a book like this: a roman de gare. In fact, a recent movie was released by the great and seemingly ageless French director Claude Lelouche (of A Man and a Woman fame) by that title. Roman de gare refers to the kind of book you might pick up at a train station, sort of a trashy novel.

If you want a fast read about strip clubs, hapless losers, wife beaters, loneliness, aging and angry fundamentalists, this book is for you. Yet it will be a notable disappointment to those who read Dubus’ previous novel The House of Sand and Fog. While both books create a clash of western and eastern worlds and characters the comparison stops there.

In The Garden of Last Days the cultural collision centers on April (called Spring when performing at a Florida men’s club), Bassam al-Jizani and AJ Carey, with a variety of other woebegones thrown in to add texture to the story. April is an enterprising twenty-something mother of a three year old who has fled a loveless family and few prospects in New Hampshire to discover she can have power and riches by dancing naked for strangers. Bassam is the youngest boy of 14 children from a respectable Saudi family, though considered by his father, a builder of mosques, to be slow and needing direction. AJ is your all-American loser who gets his Walgreen fellow employee pregnant, marries her and discovers the dream of family and home can be a very bad dream when you spend your days operating heavy equipment, your wife doesn’t love you and gets fat and lazy, and your future promises more of the same.

They all come together one night in early September 2001 in the Puma Club where Spring dances, Bassam – days before flying the American Airlines plane out of Boston that rained terror on this country – comes to experience the world of the infidels and satisfy his forbidden sexuality, and AJ is a regular seeking what he does not have at home. Only Bassam escapes the night without something broken, physical or emotional. Yet he is the most broken of all. Seeking “lasting respect” as a poor nameless and diminished Saudi man he has been taken in by Al-Qaeda, trained and promised the time of his life as all his sins will be erased and Allah will provide him for jihad sacrifice everlasting existence in a heaven populated with “…women, chaste and chosen for him only, lying upon soft couches in lush gardens watered by running streams”. Yet their collisions are only glancing with no real effect upon one another, only a moment in time on a trajectory to their respective futures.

Too little is learned about Islam in this book. Take a look at VS Naipaul’s wonderful essays in Among the Believers or Beyond Belief to find nuanced accounts of the varieties of Muslim religious experience. Take a look at Jessica Stern’s work, including The Ultimate Terrorists, if you want a chilling report on the lives of murdering terrorists. Khaled Hosseini gave us a more compelling and richer story in The Kite Runner. Even on vacation, this was a roman de gare not worth reading.

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Craving for Ecstasy and Natural Highs: A Positive Approach to Mood Alteration

Harvey B. Milkman and Stanley G. Sunderwirth

Sage Publications 2010

What do alcohol, drugs, sex, gambling, pornography, the internet, even food have in common? Drs. Milkman and Sunderwirth provide a way of thinking about these conditions that not only ties them together it makes sense. They connect the dots, or the compulsive behaviors if you will, by shining the light on the universal human desire to feel good – whether by relief of pain (emotional as well as physical), excitement or fantasy. Craving for Ecstasy exists in us all and we will need to satisfy it, one way or another.

Those that go down the path of what these authors term “hedonic dependencies” (relying on the pleasures generated by compulsive and self-destructive behaviors) discover that the highs are increasingly short lived, the price exponentially greater (to relationships, work and health), and the ability to refrain seemingly out of their reach. That is addiction.

Milkman and Sunderwirth introduced the notion of common and interactive biological, social and psychological drivers to addictive behaviors many years ago, and time has proven them prescient. Today we can better identify the reward centers in the brain and see how they light up on MRIs when pleasure is evoked – as well as see how depleted these centers become from the relentless pursuit of hedonic dependencies.  This book takes you thoughtfully and entertainingly through the complex web of brain and behavior that makes for addiction. They are great teachers.

Their theory of mind and behavior notably lends itself to solutions. To master these heart breaking conditions we have to accept our drive for pleasure and be sure to satisfy it – but in ways that add fuel, so to speak, to the brain rather than depleting it.  Funny how we seem to need reminders of what we already know. Our pleasures, healthy pleasures, derive from intimate and trusting relationships with family and friends and the “meaningful engagement of talents” (Freud called these the need to love and work). Other sources of “natural highs”, a term they use to describe non-toxic pleasures include mindfulness, meditation, yoga, massage, music, exercise and sports. They urge a balanced mind (one that has learned to train itself to regulate its thoughts and emotions) and care in what we eat and how we treat our bodies. Their prescriptions are essential to the good life, though easier for some to achieve than others.

Craving for Ecstasy unravels the biological, psychological, and social mechanisms underlying our toxic passions and demonstrates the ways we all can engage in alternative, life-enhancing means of attaining pleasure. This book is beautifully illustrated, thoroughly referenced, and written to be highly accessible to both lay and professional readers.  For a pleasurable and enlightening mental ride through the pathways of the mind and brain read Milkman and Sunderwirth’s new book. You may be surprised how much their ideas stick with you.

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Treating the “Untreatable”: Healing in the Realms of Madness

by Ira Steinman, M.D. London, Karnac Books, 2009

Published in the American Journal of Psychiatry, March 2010

There are many roads to recovery, I grant you that. But some have been shown to have a far greater likelihood of success than others; we call those evidence-based practices. For example, we know with confidence that the use of medication for people with schizophrenia reduces the risk of hospitalization fivefold, and that a comprehensive treatment of medication, family psychoeducation, case management, skill building, and problem-solving approaches reduces 1-year relapse rates from near certain to 14%. If my family member were ill, I would sure want to reduce the risks. Isn’t all health care about reducing risks?

But not Dr. Steinman, I guess. His approach, presented through 12 case studies of individuals he treated over a long career, instead holds that psychodynamic therapy, provided multiple times per week over the course of years, is an effective treatment for “the most disturbed and psychotic patients” (p. xiii). He proposes that what these individuals need is “a working through of underlying psychological issues and emotions that have been warded off” (p. xiv). But he does not stop there: in fact, he claims that we in psychiatry have “lost our way…following psychiatric department chairmen who emphasise the ‘scientific’ approach” (pp. 187–188). On a roll, he adds that psychiatry has “adopted a cult-like attitude to the benefits of antipsychotic medications and supportive psychotherapy,” which includes cognitive therapies in his lexicon of treatments.

The cases themselves are an admixture of troubled individuals experiencing psychotic, dissociative, and mood disorders, which he seems to blend together as if they were all the same and thus amenable to his singular form of treatment. The author has a tendency to accept whatever the patient says as fact (as if memory, even childhood memory, were invariably accurately reported) and to blame parents for the ills of their children. Whenever a patient does better, he attributes their success to his work, even though that same person may have left a long-stay hospital for the community or had time to recover from what appeared to be a psychosis fostered by the use of “psychedelic” drugs.

I am all for talking with patients, and some of the case material is nicely framed examples of how we all resort to defensive psychological maneuvers to avoid emotional pain and conflict, but where has Dr. Steinman been? Donald Winnicott and the object relations school of dynamic therapy of psychoses has not stood the test of time (nor has it achieved any more than anecdotal support). The author need not create dialectic between handholding and intensive dynamic therapy; after all, we have learned some things since the 1930s. No wonder he says, “I am left with a question…why did these patients not get appropriate treatment?” If he read the Surgeon General’s report on mental health, he would know something about the “science to practice gap” that bedevils medicine, including psychiatry, and would be considering ways to improve access and provide effective treatments to people in need, rather than proposing an intervention that at best should be coupled with the interventions we know to work, and at worst can itself produce regression, more years of dysfunction, and tragically missed opportunities to have a life.

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The Unit – By Ninni Holmquist, translated from Swedish by Marlaine Delargyare

Other Press, NY, 2008

Published in the Journal of Psychiatric Services, December 2009

What is the purpose of a life, the author ponders. Does a life, yours or mine, exist to sustain the collective and its wellbeing – where value is in what a person produces – or does life have intrinsic value – where purpose derives from who a person is?

In the society that Holmquist creates for her readers the former has hegemony. If you are 50 as a woman or 60 as a man, living alone, without child and not a critical worker, you are designated as “dispensable” and go with trepidation but without resistance to a “Reserve Bank Unit”. There you become a source of biological material (which means your organs are harvested, one by one – a kidney, a cornea, a slice of your liver) and a subject for experimentation until your utility is complete, at which time you make your “final donation” ending your stay in the Unit.

In Holmquist’s eerie, chilling yet almost plausible social order all citizens exist to further the gross national product: lives either advance or diminish the “capital” of the nation. Value (and meaning) issues from an individual’s contributions to the national capital; for some, that means disappearing one day from their community and entering the Unit where they further the social good as donors of body parts and subjects for advancing the scientific knowledge thought useful to the GNP. And the GNP has been prospering so the Unit can afford to be an ideal setting where comfort prevails, everything is free, and people have the time to attend to one another as the burdens of everyday existence vanish – as did its entrants from their antecedent but dispensable lives. For those residents of the Unit having trouble adjusting, and they appear numerous, there is an ample supply of capable psychologists to assist with coping (when they are not busy performing mind or drug experiments); physicians are occupied removing organs and aiding in physical recovery to prepare a dispensable for her or his next contribution.

One has hopes for the protagonist, Dorrit Weger, who falls in love with another resident of the Unit and whose life changes in a profound way. She rails against the pain she witnesses in those around her and for the grief of those still alive. At one point, Dorrit’s anguish enables her to see, through the veneer of this well ordered society, that her accommodations are a “luxury slaughterhouse”. Holmquist maintains the tension throughout and draws the reader into railing against what seems on the surface so reasonable yet curdles the blood.

This moral tale may be more credible to the European or Asian mind where the individual is more subordinate to a community ethos, as we witness since health care and education are universal in all but one advanced (western) culture. An ethos of community before individual would hardly fly in Texas, Oklahoma or Montana, to mention but a few places in the US. Yet Holmquist gives us a lesson in human nature and social engineering through a story that is spare, compelling and all too human. I am reminded of what the great urbanist, Jane Jacobs, wrote: “Perhaps the greatest folly possible for a culture is to try to pass itself on using principles of efficiency.”[1] However adorned, the totalitarian state in waiting bears vigilance since it seems to meet many a human need.

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[1] Jacobs, Jane: Dark Ages Ahead, Vintage Books, NY, 2005, p166.

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MOVIE REVIEWS

MOVIE REVIEW: The Best Exotic Marigold Hotel – for the elderly and beautiful

Why do people of older age seem so incapable of transformation? What circumstances and settings can unleash irresistible forces of change upon human passerbys, regardless of their age?

Conjure up those transformative forces. Aim them at persons of advanced age, entrenched habits and deeply rooted fears. Throw in the wondrous catalyst of an ancient culture (suffused with modernity) where life is considered a privilege and an (almost) endless journey. You now have the plot of The Best Exotic Marigold Hotel.

 You can go to this film and bear witness. But remember the Indian expression: “everything will be all right in the end. So if it is not all right, it is not yet the end.”

Seven Brits, one couple and 5 singles, facing retirement conclude their finances cannot meet the monthly costs of the comfort they seek in their dotage (with one notable exception, whose motives unfold as the story is told). Their paths collide in Jaipur, once home to Rajasthan rulers, at the hotel that proclaims blissful, and affordable, premises in a distant and exotic world.

This film glories in its world class cast. These are actors whose own personal lives embody the movie’s message that youthfulness need not be confined to the young : Dame Judy Dench (as Evelyn, recently bereaved and on her own for the first time in her long, sheltered life); Tom Wilkinson (Graham, who has peremptorily left his seat as a High Court Judge to return to where he came of age); Maggie Smith (as Muriel, the cranky, discarded housekeeper who could not tolerate the six month National Health Service queue for a new hip that could be done right off by contracted Indian doctors and then rehabilitate at a ‘resort’); a married couple (Bill Nighy and Penelope Wilton – as Douglas and Jean) in the desolate winter of a loveless marriage; and Celia Imrie (Madge) and Ronald Pickup (Norman) as fellow lonely travelers in a world inhospitable to elders. These are an amazing ensemble of master actors.

Remember the boy who literally took the leap into excrement en route to ecstasy in Slumdog Millionaire, played by Dev Patel as the young game show contestant? This ebullient actor welcomes the magnificent seven to his hotel, where he is manager and about everything else in a place built on dreams. His business model is to “vendor out” services for those the rest of the world has in excess and wishes to be rid of, like the elderly. His energy is uplifting but his hotel is a dump.

Upon their arrival at the Best Marigold, this proper group of despairing characters faces the brutal existential question of whether this is the sorry end of their lives. But they are not dead yet! They dare to pursue the ageless quest of reviving broken bodies and spirits – just like The Best Exotic Marigold Hotel also needs to do with its crumbling buildings and unsettled ancestral ghosts.

Under the crisp direction of John Madden, the cast takes us on a transformative journey. Madden has mastered the stage (the Pulitzer winning Proof) but his string of Hollywood films has yet to break the Oscar barrier, despite his ample employment of Oscar-winning stars. His directing in this film skirted with schmaltzy but, for me, never seriously crossed the line. This movie makes for smiles, amidst tears.

This film was co-produced by Participant Media (Company with a Conscience, http://www.huffingtonpost.com/lloyd-i-sederer-md/company-with-a-conscience_b_854598.html)that recently gave us The Help and Contagion, and, in the past, An Inconvenient Truth, Syriana, The Soloist, and dozens of socially laced films. Each of their films is accompanied by a social action campaign: Participant’s mission with The Best Exotic Marigold Hotel is to stimulate seniors to continued lives of adventure and contribution. As someone old enough for Medicare, I am all for that.

Will the film appeal to more than a grey haired, achy, population of seniors? I suppose it needs to for box office success. But as they say at the Best Exotic Marigold Hotel “…real failure is failure to try.”

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A Dangerous Method: notes on a film about Freud and Jung

I am no apologist for either Sigmund Freud or Carl Jung but this film was a petty, if not perverse, rendition of a profound moment in the intellectual and social history of the Western world. What makes the film’s treatment (no pun intended) of this era so troubling is that not many know the actual story about the origins of psychoanalysis and psychotherapy, nor of its twin human pillars – namely, Freud and Jung.

It is 1904 and a horse drawn carriage is transporting a writhing and screaming young woman to the Burgholzli Clinic in Switzerland. Her Russian, Jewish, bourgeois family has sent her to this renowned treatment center where she will be cared for by the gifted Dr. Carl Jung (Michael Fassbender). The Burgholzli Director, Herr Doctor Eugen Bleuler, had gained fame for naming “schizophrenia.” Bleuler described this disorder in a more hopeful manner than had Emil Kraepelin who had earlier called it Dementia Praecox, signaling an early and hopeless course. Jung too was an innovator, like his mentor, and had read Freud’s accounts of the ‘talking cure’ (as it was called). Jung would try it on his new patient, Sabina Spielrein (Keira Knightley). Almost instantaneously, she recalls humiliating thrashings by her father, dating back to when she was four. Very soon thereafter, she adds she relished the abuse. That’s short term therapy if I ever saw it.

Spielrein is a perfect patient for the ‘talking cure’ – to distinguish this approach from the purgatives and emetics, bloodletting, cold baths and restraints that constituted too much of 19^th century hospital psychiatric treatment. She was intelligent, highly educated, Jewish, and suffered from the condition then known as hysteria. She was not psychotic, nor did she have depression or bipolar disorder. She had fits, like the infamous hysterics treated by the great doctors of 19^th century French psychiatry (especially Charcot and Janet). Bouts of hysteria are wildly expressive behaviors and Knightley embellishes them to a fare-thee-well. Sabina, like the grand hysterics of her era, was trying to communicate through her body and her symptoms what she could not say in words because of shame, repression and the oppression that was the fate of being a woman in Victorian times. 

Freud (played cautiously by the usually uninhibited Viggo Mortensen) claimed that his treatment could turn neurotic misery into ordinary unhappiness. Jung’s ambition for Sabina was far greater, it was Pygmalion: he would help her become a doctor. Jung, married to a devoted and very rich wife who bears him five children, soon invites his patient to assist in his research. From bench to bedside, but not in the traditional sense of how science goes from the laboratory bench to its use in hospitals for patients. Instead, we see him do the ethically unspeakable, namely have a torrid sexual affair with his patient. While this indeed did happen, the dominance it has in the film is unfortunate – especially since what may be most disturbingly memorable from the film are the sadomasochistic sex scenes so graphically performed.

The relationship between Freud and Jung has intrigued many an author. A Dangerous Method dwells on the father-son aspects and caricatures both men. Freud is the rigid, doctrinaire Jew aspiring to a place in society who spent most of his adult life trying to earn enough to support his large Viennese family. Jung is the wealthy, aristocratic Swiss Protestant who is getting special messages from the universe that became instrumental to his later theories about archetypes. Freud saw human nature as driven by unconscious forces of sex and aggression where Jung saw a ‘collective unconscious’, the repository of human experience from time immemorial. Where Freud saw fate perhaps it could be said that Jung saw opportunity. 

Sabina serves as a link and a source of conflict between the two men. Freud was appalled by Jung’s taking his patient as a lover. He was also threatened by Jung’s ideas and the impact they could have on the fledgling field of analysis. Jung was enraged by Freud’s determination to rule psychoanalysis and dominate Jung and dismiss his ideas. Sabina does become a doctor and psychoanalyst who challenges Freud himself but returns to her perverse relationship with Jung, and then rebuts him. Yet there is far more going on and the film seems to not appreciate the history of early 20^th Century Europe with the rise of totalitarianism, the persecution of Jews, and the nightmare of Hitler. It also does not credit these two psychiatrist pioneers with advancing theories of the mind that changed the Western world.

Freud had to flee his country to escape the Nazis. Many contend that Jung became a Nazi sympathizer. Jung had a severe and several year long episode of psychosis, recently illustrated in the publication of The Red Book, full of mysticism and primary process material. Freud did open his mind to the role of the ego, the rational part of the mind, and his daughter, Anna, was extraordinary in her work. She explained how our mind works through ‘defenses’, like denial, intellectualization, repression, sublimation and passive aggression, which are now part of our vernacular. Jung recovered from his psychosis and has left us with an understanding of the deepest of individual and social determinants of behavior. There was far more going on than Carl bedding and beating Sabina or Freud frowning upon that disgraceful behavior, which the film tends to leave you recalling.

David Cronenberg, the film’s director, and the writers, appear to have missed the plot. They had a phenomenal story and the finest of actors. The audience could have left the theatre without indelible images of abuse in the forefront of their experience. They could have been illuminated by the mental and spiritual human wellsprings revealed by these great men, despite all their limitations, which are among the most profound influences we have on our minds today.

 

Originally published in the AOL/HUFFINGTON Healthy Living Section on December 2, 2011.

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UNGUARDED: The High Life of Chris Herren

After the movie screening in the Tribeca Cinema in Lower Manhattan as he settled into a stool, microphone in hand for the Q and A, Chris Herren rubbed his left knee – the knee that hurt too much to continue to play for the  Boston Celtics and accelerated his dependence on drugs and alcohol.

The occasion was a preview of an ESPN documentary (“Unguarded” – November 1, 2011, ESPN, directed by Jonathan Hock) on the high life of this gifted athlete from Fall River, Massachusetts, who wowed them at Durfee High School and onto a pro career that was as brilliant and transient as a comet in the autumnal sky.

You will want to see this film if only to marvel at the moves this basketball guard displayed from his days in the playgrounds of Fall River, to Boston College, to Fresno State under the wing of the legendary gnome-like Coach Jerry Tarkanian. Drafted by the Denver Nuggets in 1999, he was traded to the Boston Celtics in 2000. Man, could this handsome, beaming, arm pumping athlete drive, pass and shoot. Even under the influence.

But ultimately, his arms were where he stuck a needle loaded with heroin. He traded a shelf of trophies for a rap sheet of felony convictions. His fans booed him. His family cried from the pain he brought upon himself and them.  He converted ‘nothing but net’ into nothing but a life compulsively driven by dope. As painful as that is to watch, imagine what it must have been to live.

Chris Herren went from drinking and grass to his first line of cocaine when he was 18. But it was narcotic pain pills that took him to the major league of drug addiction. First it was Percodan™, then Vicodin™, but not until Ocycontin™ did he become a pro. Life centered no longer on basketball: it centered on scoring this pill that has become a nationwide killer of people, not just pain.

There is an expression in the world of addictions: ‘the man takes the drug, the drug takes the drug, the drug takes the man’. Soon Herren was taking Oxycontin™ not to get high but to manage the withdrawal, the ‘dope sickness’, that comes when the body is denied a substance upon which it has become dependent – the drug takes the drug. When his wife took the car keys so he couldn’t drive to his drug dealer 12 miles away he got on his 10 speed bicycle and pedaled, on the highway, to get his fix. When he went to play basketball abroad – no longer USA material – first in Italy, then China, Turkey, even Iran, he upped his game to heroin when pills were not readily available. The drug had taken the man.

He had been at rehab a few times, in college and the pros. I have learned no one ever knows when the life-long process of recovery will ‘take’ – when the repetitive relapses will transform into days, weeks, months and years of sobriety. For addicts, families and my fellow clinicians the message is never give up. You may not be able to predict when that will happen, but it sure does, more often than we imagine.

As it did happen with Chris Herren. He was blessed with a loving and enduringly supportive family. He had not only the gift of being a great ball player, but he had (has) the gift of being amiable,  the kind of person you want to succeed,  almost no matter how much he has hurt you and others. He was given really good treatment. It was Daytop, a drug treatment program in the New York area begun in the 1960s, and the unbending demands of its counselors, that helped Herren find his heart and soul once again. The man has emerged from the drug.

Chris Herren is the father of three children and still married to his childhood sweetheart. He is now more than 3 years into his sobriety and coaching youth basketball. His smile warms your heart. You want him to win. He tells his story with humility and with the hope that someone, some youth or aging addict, or person at risk for a life too full of ruin, will find hope, treatment, and the road to recovery. One day at a time.

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Contagion: Scary Movie

A minuscule space separates health from disease and peace from pandemonium. It can be readily and rapidly crossed by a weapon of mass destruction that is invisible to the naked eye but possessing of a means of delivery that is ubiquitous and virtually unstoppable. The weapon is a virus and its weaponry human beings. It is by touch, breath, cough, and sneeze that many a virus is transmitted: we put our hands to our face as many as 3,000 times a day – after touching countless door handles, counters, dishes, and papers. The body count from a highly virulent strain depends upon what is called R-1 (or 2, or 4, or 8), the rate of its spread among its victims. Flu spreads at R-1, Smallpox R-3, and Polio R- 4-6. At a rate of R-4 the virus can infect 1 in 12 people on the planet (!) in a matter of months.

Pandemics, or epidemics of infectious diseases that impact very large numbers of people across great distances like countries or continents, are well known. Swine flu (H1N1), avian flu, SARS, smallpox, and polio, to name a few, can raise our emotional temperatures at the mention of their name. The so-called Spanish Flu of 1918-1919 killed 50 million people, more deaths than attributed to World War I. Their unpredictability is unnerving and their medical, social and economic costs can be incalculable. The telling of this macabre story in film is what Contagion exposes us to. When there is no known treatment and no vaccine, that’s a potential body count in the hundreds of millions. That beats about any other scary movie I have seen.

The following link will take you to a 2+ minute animated video of how a “Virus Changes the World.” Buckle your seatbelt, and don’t touch anything… http://www.youtube.com/watch?v=qZTMT89EAHM

Contagion also packs a punch with its ensemble cast who are viral in their capacity to infiltrate the movie going public. There is Gwyneth Paltrow as the business woman/wife returning from Asia transporting the deadly disease; Matt Damon as the immune but bereaved husband determined to save his daughter; Laurence Fishburne as the Centers for Disease Control and Prevention (CDC) chief on the case and Kate Winslet as the dedicated epidemiologist field officer sent to investigate the outbreak where Gwyneth released it; Marion Cotillard is dispatched from the World Health Organization (WHO) to Asia where the virus was born de novo and the contagion likely began – actually called Ground Zero (and this film comes out immediately before the 10^th anniversary of 9/11); Jude Law as the despicable blogger out to exploit whatever he can; and even Elliot Gould as the indomitable, salty scientist who no bureaucracy will deter.

Directed by Steven Soderbergh (Traffic, Erin Brockovich, Ocean’s 11 and its mutations) this film advances as fast as its subject. We are taken on a pandemic ride that churns up fear and will not be likely to forget. Which is, in part, what the film aims to achieve. Participant Media (see Company with a Conscience http://www.huffingtonpost.com/lloyd-i-sederer-md/company-with-a-conscience_b_854598.html) added its imprimatur and capital to this production to raise awareness of pandemics, identify and support the good guys, and help us all understand what can be done when faced with an enemy so powerful and merciless.

The war against a pandemic is waged on two fronts: the disease itself and the panic that ensues. Principles of containment for an infectious disease are well known: isolate the exposed, quarantine the sick, and engage in a set of behaviors that prevent spread such as hand washing, covering coughs and sneezes, not touching just about anything, and the like. Then figure out what is causing the illness and how to treat and prevent it. Panic is another matter because it can give rise to primitive, mob behaviors where the rules of civilization and law seem also to have been destroyed by the disease. Still, social control can be achieved and most people will find the humanity at our core. We are a resilient lot, in body and mind.

It is a good thing we have science and government, one has to believe, at the end of this film. Where would we be without the CDC, the WHO, irascible and irrepressible scientists and a disciplined military used to preserve humanity, not destroy it? Where would we be without the National Institutes of Health to fund the basic research these medical (and military) soldiers need to do their job? Where would we be without responsible media that does not exploit human disaster but does what it can to help us all reach a higher moral ground? I just wish the filmmakers had been kinder to bloggers.

Originally published in the AOL/Huffington Post Healthy Living Section on September 9, 2011

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“Buck”: no horsing around

A documentary film about Buck Brannaman, directed by Cindy Meehl, 2011

“Buck” in its own seemingly effortless and totally endearing way is a film about violence.

Violence comes in a variety of forms: physical, sexual, and emotional – commonly in combination. Violence is visited upon fellow human beings – young and old, family and friends, and random strangers – and those creatures that fall under our control, be they dogs or cats and, case in point, in “Buck” it is horses.

Whole agencies are created, funded and staffed to protect against violence (e.g., child protection, elder abuse, cruelty to animals) and a vast criminal justice system of courts, jails, prisons, parole and probation exists to help contain it. Yet violence endures unmercifully.

The closer the perpetrator is to the victim the more corrosive the damage. Sadistic parents have a profoundly deleterious effect, as do siblings and other close relatives. The more persistent the abuse the greater its impact and without someone to step in to protect the deeper are the wounds. In the most chilling and counterintuitive of ways, people who are violent have been almost always themselves victims of violence, thus its transmission from generation to generation.

“Buck” is a documentary film about Buck Brannaman, nearing 50 and now a legend as a ‘horse whisperer’ – though that term hardly does him justice. He spends nine months of every year criss-crossing the USA doing four day clinics on how to be one with your horse. As one narrator put it, “…some horsemen have a handful of tricks, Buck has an arsenal.” Though that too does not convey the essence of what he does, which is to inspire the person who brings his or her horse by teaching confidence and skill and compassion. To paraphrase Buck, it is not a problem horse he sees but a horse with a problem owner.

Rewind Buck’s life, as the film does, and we see him as a blond haired, blue eyed boy, the younger of two sons, who was a child cowboy star at the remarkable age of four who even did ads on TV for a cereal brand. But this all-American family was ravaged by violence which reached full force after his mother died and his father, then an alcoholic, began to beat him and his brother every night, for years, until a football coach discovered the welts and called the local sheriff. He was taken in by the Shirley family (his foster mother is a featured character in the film) and given a chance to live without abuse and to learn a life of ranching and responsibility as part of a caring family that had as many as 23 (!) foster children, all boys.  So begins his exit from the cycle of violence.

Buck finds his calling when as a young man he comes upon Ray Hunt, his great predecessor as a horse trainer. He witnessed that “breaking” a horse could be done without aggression or violence, long a tradition among horsemen. Buck’s path was fashioned at that moment as he tells us in one of his many reflections throughout the film. He spends years learning from Hunt, modeling himself after what was ‘the good father’. He would not be his father inflicting pain and terror but rather a person who could be firm, attuned, disciplined, kind and show how that could be done through the vehicle of training horses. And when you see that done, I assure you, it is a sight to behold.

What makes this film so extraordinary is not just how amazing a figure Buck is but the way the narrative illustrates how violence can be mastered. We witness Buck who leaves the legacy of violence behind (but not forgotten as he remarks) and the countless horsemen and women whom he has helped discover that you can make a horse dance or herd cattle without pain because in the end that horse wants to take pride in its work just as much as you do. The examples in the film of his skill with horses and people are arresting, each one a heartbreaker, even when he fails, as happens with one horse and its owner. We are treated to Will Rogers’s like philosophy that is not only voiced but undeniably shown in horse corrals,  stables and training clinics while drinking in gorgeous footage of the cowboy life and the American West.

I wish I had a horse so I could go to one of Buck Brannaman’s clinics. I don’t. But then again, it’s really not about the horse.

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The Dark World of Depression: The Beaver (Movie Review)

Is there a different sort of ‘depression’, a deeper form, which does not respond to psychiatry’s remedies? Is this what ails Walter Black (pun intended?) (Mel Gibson) as he becomes progressively disabled, failing in his role as the son who inherited the mantle of the family (toy) business, and as a husband and father? We see his medicine shelf loaded with pill bottles that have provided no relief. We see him banging on a drum engaged in some off-beat therapy that’s not taught in psychiatric programs I know. We learn he has stopped seeing his psychiatrist as there was nothing to be gained. It is not looking good for Walter, nor his good wife, Meredith (Jodie Foster, who also directs the film) and their two boys. That black monster, despair, has gripped Walter’s soul and is pulling it ever downward to hell on earth, where suicide seems his only exit.

The older son, 17 years old, named Porter (pun intended?) (Anton Yelchin), appears to be carrying forth the same demon on to his generation. Walter and Porter’s blackness is all the darker as it is contrasted by Meredith, loyal and dedicated to serving them, and the angelic younger son, Henry (Riley Thomas Stewart). How much can a saintly wife bear? How resilient can a young child be to the wrenching pain around him? What are the furies father and son conceal and what fuels them on their self-destructive paths until all they can see is hopeless in its cast?

Yet the pain does not stop there. To echo the Black family’s journey into angst, Porter’s love interest, Norah (Jennifer Lawrence, having wowed us in Winter’s Bone http://www.huffingtonpost.com/lloyd-i-sederer-md/a-heros-journey-emwinters_b_638824.html), also lives a life of agony, though she is still able to keep her trauma and its consequences secret from those in school, where she is a cheerleader and scholastic success – except for Porter who can spot a fellow traveler.

Enter The Beaver, the movie’s namesake: first, the furry puppet is a “miracle”, a “prescription puppet” more powerful than a serotonin uptake inhibitor. Unconventional treatment for sure, but not after drum beating and Prozac have failed to cure; mind you, we have a toymaker to spawn the idea. The Beaver takes Walter, literally by the hand, from the abyss and leads him onto the tough road of recovery. The Beaver is Walter’s alter – the person he needs to be but cannot mobilize – the force that will restore his sanity, his family and his business. But then, in keeping with any deal with the devil, The Beaver becomes a monster who shall not be denied. The Beaver turns out not to be medicinal; he is a deadly force himself. He becomes inseparable and demands unbridled love and commitment. The Beaver becomes a habit that in time will take far more than it gives. Where was the package insert that warned of its risks?

The Beaver is a film that does not approach depression or recovery in the ways that American psychiatry denotes. Walter appears to suffer, as does Porter and Norah, from a condition more complex, beyond standard textbook diagnostic criteria and treatment guidelines. Is it bred by trauma – the trauma of loss, violence, abuse, even cold indifference? What is the intergenerational fate its victims carry? How does the monster of despair, whatever its genesis, fiercely grip our soul and refuse to let go?

The film was directed by Ms. Foster and these are some of the questions she has engaged. I can’t see how anyone has thought of this film as comedy, though there are funny moments and some light music. It is hard not to think of Mr. Gibson as portraying on screen his off screen troubles that have made recent and sensational headlines. And hard not to think of Ms. Lawrence continuing her true grit portrayal of an Ozark mountain teenager left to save her family from losing the meager life they have.

The film gets very dark before the light returns. Brace yourself. But that is no different from the course of so much of what we know of as despair, individual and often societal. Walter’s separation from the Beaver is brutal but necessary to permit (an also painful) passage to recovery – for Walter, Porter, Norah, and even for Meredith, as she gets her family back but in ways that bear little resemblance to the memories that once were her source of hope.

Beavers build but they also dam (pun intended); they bring down mighty trees to serve themselves; from teeth to tail they are equipped to be weapons. The Beaver is no cute pet, and this one probably deserves burial in Stephen King’s Pet Sematary. The moral is clear: Better to let the demons out than to create and live by another. Better to seek the company of family and friends, as human and faulty as they surely are.  Better to not give up on the human spirit for while it may be hiding out of sight it is not gone.

This review initially appeared on May 6, 2011, in the Huffington Post

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LIMITLESS — Would the FDA approve?

One pill makes you larger

And one pill makes you small

And the one that mother gives you

Don’t do anything at all

Go ask Alice

When she’s ten feet tall

From the White Rabbit by Jefferson Airplane

And I thought that tune was dated. But not after I saw Limitless, the film starring Bradley Cooper (Eddie Morra) and the legendary Robert DiNiro (Carl Van Loon), and directed by Neil Burger.

A writer, Eddie, who cannot put two words in a row on a page finds himself unable to deliver on the book he somehow has had an advance on, his beautiful and talented girlfriend (Abbie Cornish) hands him back his apartment keys and says goodbye, and dishes and debris pile up around him in the shambles of his apartment in New York’s Chinatown. He has been drinking too much and now has cause to drink more. But chance happens upon him as his ex-wife’s brother spots him on the streets of New York, asking if indeed that is his address. Vernon (Johnny Whitworth), a former drug dealer we learn, looking quite dapper and well to do, takes the sad sack Eddie out for a drink, not hard to do, and offers him a pill that will change everything. One pill makes you larger. What the hell, what does Eddie have to lose?

And so begins his adventure, as Vernon supplies him with NZT (why does my mind go to AZT, an antiretroviral medication for HIV/AIDS?), a drug that takes his limited brain functioning – we use a fraction of our brain’s capacity – and delivers it to its totally unharnessed power. He becomes limitless – soon making a fortune and is featured in the NYC tabloids as its latest phenom. It is an ascent meant to inspire envy as he rockets to success on Wall Street and in the trendy bars of NY where one beautiful woman after another cannot resist him. He woos a billionaire investor, Carl Van Loon, into taking him on as his principal advisor as the tycoon plots the largest (sic) corporate merger know to mortals, ironically involving Libya and oil! Hah, hah!

However, though NZT makes you larger it then makes you small. The drug begins to destroy the brain and the body through which it streams. The outcome is fatal unless the user continues to employ the drug, and even then it has a track record of debilitating its host. As if that were not enough, Eddie becomes the target of a variety of bad guys, each with his own special and savage evil intent. Inside and outside his corporal existence, Eddie is in big trouble. The acting is terrific, the film pace brisk, and the story line hurtles forward. It is not looking good for all wrapped up in the NZT and corporate worlds. Soon the body count exceeds many an Arnold Schwarzenegger film, though the causes of death are more varied.

I was on board for all that. It was the resolution that troubled me. Remind you, I am a psychiatrist and public health doctor. Eddie, now looking All-America, is no longer a sketchy writer, a drug addict in withdrawal, or a corporate icon in hand made suits; in fact, he is about to become a Senator (and not a state senator) from New York. Carl Van Loon tries to co-opt him by taking control over Eddie’s supply of NZT, so he thinks. But Eddie, smiling brightly, his blue eyes ever more radiant, has him beat. Eddie says he is off the drug, even suggesting he has found ways to make it less toxic. But though off the drug Eddie is no less the incomparable genius he had become. We get some line about his brain having been altered in ways that make Einstein look like Harpo Marx. Eddie’s brain has incorporated the drug’s benefits, has no residual adverse effects, and is now the man that stands to rise to President of the United States of America. Obama beware.

I have written about cognitive enhancers (Neuroenhancers: Paying the Piper – http://www.huffingtonpost.com/lloyd-i-sederer-md/paying-the-piper-brain-ne_b_209702.html). In fact, the film mentions the “enhanced Eddy.” Limitless seems to proffer that we can dodge the damage of drugs, that you can take a neuroenhancer, a pill as potent as can be envisioned, and come out the other end of your own drug deal of sorts as a Senator, if not a President, with your love life restored, your crimes forgotten and your wealth, uh, oh yes, limitless. Go ask Alice, When she’s 10 feet tall. Maybe the FDA should be asked to review this film?

Originally published in the Huffington Post, April 7, 2011

http://www.huffingtonpost.com/lloyd-i-sederer-md/limitless-movie-would-the-fda_b_845428.html

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The Fighter: All in the Family

Originally published in the Huffington Post on December 28, 2010

The Wards of Lowell, Massachusetts, are no ordinary family. Dicky was a contender and knocked down Sugar Ray Leonard (or did he slip?) earning him the title of “The Pride of Lowell.” He taught his younger, half-brother, Micky, everything he knew about fighting so when Dicky went on to a life as a crack addict and felon, Micky stepped up hoping to become welterweight champion of the world. But in his corner, as trainer and coach, was Dicky. Their manager? Alice, their chain smoking mother of nine, through at least two husbands, who never stopped believing – in Dicky and her invaluable role in the lives of her children.

This is the family we meet in a depressed city straining as well to restore its pride, lost long ago when industry turned its back on towns like Lowell throughout this country. This is the family we get to know (and dislike so many of its members) in “The Fighter.”

Families are not just collections of shared genetic material. They are living, complex organisms where each part contributes to the whole. Never you mind that one part may seem so different, even toxic to the whole. Never you mind that one member may be as unlike the others as, say, Archie Bunker (Carrrol O’Conner) was to his son-in-law Michael, known affectionately as “Meathead” (Rob Reiner) in “All in the Family” – or when we see a priest and a convict emerge from the same family.

We are the sum of our familial and developmental parts. Those parts are the building blocks of our person – inescapably put in place by parents, brothers, sisters, cousins, grandparents, and those nuclear to our family and our community. Try to take away a part and what happens? Things don’t seem to work so well. That makes sense since something, someone, fundamental is missing: like body without a heart, or brain, or organs of locomotion; or like a car without a transmission, or brakes, or roof to keep out the rain.

As I watched “The Fighter” I wondered, even as a psychiatrist with what I think of as years of experience, how could Micky tolerate his insufferable mother? How could he not see how his family was ruining him and continue to subordinate himself to his crack addicted and destructive brother? Or not laugh at his bizarre gaggle of sisters with more hair than brains? I had turned off my psychiatrist’s brain. I had forgotten that we are attached to our families for better and for worse, and that trying to move beyond them is no easy feat, nor is it necessarily done by leaving them.

So it is with the Wards as we are glued to their tale in “The Fighter.” Mark Wahlberg is Micky, the younger of two brothers who cannot find the spine to assert himself in his family. Dicky, brilliantly played by an almost unrecognizable Christian Bale, must find a life beyond his fantasy of a comeback at forty and the corrosive effects of crack addiction. Melissa Leo, as mom, delivers a portrayal of one of the most despicable mothers I have seen in a long time. But the story is as importantly about O’Keefe, the Irish cop from the neighborhood, and George (Jack McGee), Alice’s harassed but not humbled husband, and the muse, Charlene (Amy Adams), the red-head, college dropout, bar waitress that Micky must win in order to win a life beyond his family and become a champion boxer.  

The brothers need each other. They are family. But they need a family that is not driven by self-absorption and drugs but one reconstructed in its unique crucible of failure, pain, prison, and brotherly love. Micky and Dicky need to find a way beyond the past, a means of transforming themselves in their dysfunctional family and on the impoverished streets of Lowell, Massachusetts.

Micky cannot, nor must he, leave his family. He discovers that leaving is not the answer. He needs his family, as he needs those that take him beyond his family, as do Charlene and O’Keefe. Severing a part of himself like his family (like cutting off an arm, another recent metaphor for survival) is not how Micky survives and achieves. It is by finding himself – by doggedly fighting to create the terms by which he will be a part of his family, namely, his own terms. That’s the winning punch.

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The King’s Speech: Making a Life with Disability

Thoughts about the film starring Colin Firth and Geoffrey Rush, and directed by Tom Hooper (2010)

 

Originally published on December 14, 2010 in the Huffington Post

Don’t hesitate, don’t stammer, when thinking about going to see this movie. Not just because Colin Firth and Geoffrey Rush (and Helena Bonham Carter) are riveting or because of its brilliant period perfect glimpse into everyday British royalty amidst a Europe rushing towards its second world war or because we get to see the seemingly immortal Queen Elizabeth as a girl. But because it is a story of courage amidst disability.

It was the 1930’s, King George V was dying and the throne was to be passed on. Upon the tough and trusted monarch’s death his oldest son, Edward, became King. But not for long. Immature, impulsive, dependent on a married American woman (Mrs. Simpson), and unable to bear the mantle of King he soon abdicated the throne. His younger brother, known among the family as ‘Bertie’, became King George VI. Those are the facts. But there is more. Bertie stammered, severely, from age 4 or 5 and his subjects around the world suffered whenever he tried to deliver upon his princely public responsibilities. He put himself out there nevertheless and tried a variety of treatments, with no success. Facing becoming King, however, his choice was to retreat or to “Keep Calm and Carry On”, how the Brits have come to depict their national character.

If you stammer, however, keeping calm, no less carrying on, is hard. And if you are a Prince, or worse, on your way to becoming King, and face a world that will need confident leadership to withstand the terror of war and the harrowing threat of Nazi tyranny you have a big problem on your hands because how can your empire find assurance in their King if he cannot speak to them without failing with every word?

What we have the great pleasure of witnessing in this film is the transformation of a man. His courage in the face of disability is presented in its full humanity since his road, too, has big bumps and deep ruts that derail. His disability was speech. But I thought it could have been depression (or any other mental illness), cerebral palsy, epilepsy, or so many other conditions that produce impediment but need not consign a person to a compromised life. And I know, from countless examples, that a person burdened with disability can make a life with disability, can have a life of dignity and contribution.

But Bertie could not do it alone. That is a fundamental message of the film. He had, in the end, a ‘team’ to help him. The team begins with his wife, who married him on his third proposal, and was a reluctant monarch herself. She finds Lionel Logue, an Australian speech therapist known for his unconventional methods – hardly whom royalty might consult. Lionel must win the trust of Bertie (as Prince and later as King) and to do so he must also establish himself as an equal. This is no small feat, since trust (or equality with a royal!) is not won easily or quickly, presenting a necessary, if formidable, test of Lionel’s resolve and technique. As it must, for it is this trusted relationship among equals, their friendship, which provides the crucible for the transformation. Doctors, therapists, helpers of all stripes, pay attention: it is not authority that provides the foundation for healing and recovery, but trust and equality.

What made this man’s transformation all the more credible is that trust and support, alone, were shown to be necessary but not sufficient. Functioning beyond disability requires skills. Lots of them, learned and practiced again and again. Bertie had to have the will to recover, the support of family and friends (even of Churchill, a childhood stammerer himself), and an expert to teach him how to function beyond his disability.  Lionel was highly skilled and a great teacher whose techniques gave Bertie what he needed to manage his stammering and become one of the needed voices of the western world during a very dark and uncertain time. And Lionel was no better, and no less, a person than his student, the King of England.

We all have our limitations – some more than others. When pronounced we call them disabilities. Facing and fighting the demons of disability – our own and those that culture and society can hail upon the disabled – is the gauntlet of those who confront the choice of a life of retreat and shame or one of engagement and pride. The path of a life lived rather than a life missed takes will, true friendship and learned skills. Hats off to the Bertie’s and Lionel’s of the world.

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A Hero’s Journey: Winter’s Bone

2010 Starring Jennifer Lawrence, Directed by Debra Granik, From the novel by Daniel Woodrell

Published in the Huffington Post on July 9, 2010

What do you do when home and family are in peril? When your mother lives in a psychotic fugue too far removed to help, when your siblings are too young to care for themselves, the relatives too deranged to let them take over, and dad is missing and sought by the law?

Ask Ree Dolly. While only 17 she has come of age in the desolation of the Missouri Ozark mountains. While called ‘child’ by those who seek to dominate her she long ago discarded any innocence.  Yet she has integrity and drive, qualities that are about to be assaulted, literally and figuratively, by those closest to her.

We enter Ree’s life as the sheriff drives onto property that seems a burial ground for cars, tires and lost souls. Winter is setting in and frost permeates the air. Warmth comes in small and fleeting doses. “The law”, as he is called by everyone, brings bad news: Ree’s father, Jessup Dolly, has skipped bail and cannot be found. Unless he appears in court next week his bond, made by putting up the family home and woodlot, will be seized. She, her brother, sister and mother will be homeless as the cold hardens around them. The law cannot find her dad but she says “I will”.

Jessup was awaiting trial for cooking crank (running a home lab that makes crystal methedrine) before he disappeared. In fact, most of the Dolly family is in this business as a generation of ill fate, glimpsed from photos in an album, has delivered them to poverty and its desperations. Even their farm ‘crop’ has changed from marijuana to meth. They are also consumers of their product – at least the men are – so their brains are on fire with the drug and their behavior is as unpredictable as the mountain weather.

The accounting unfolds as Ree begins her search for her father. Like every hero’s quest there are abundant dangers, surprising and shifting enemies and allies, and resolve to be tested every step of the way. Men menace their women but it is the women who are strong. Family loyalty is in constant tension with doing what is just. Ree’s journey fills us with suspense as prospects for finding Jessup and saving her family dim.

The pain Ree suffers is hard to take. She seems so strong but no one is that strong. Can it be worth it? Yet she acts without hesitation to retain her land and the meager future it will yield. Some of the scenes are deeply primal. Jennifer Lawrence’s capacity to render agony, grit and tenderness is a sight to behold, if you can stand it.

Winter’s Bone may be one of the best films we will see this year. It is an independent film with a two million dollar budget that spells promise for American movies. A movie of this power, that depicts a journey of necessity and determination, embodied by an ageless young woman, inspires and lends hope about those we might otherwise count out.

This film is a testimonial to human survival without a hint of pretense. All is shown, nothing has to be said: the story line and character portrayals do all the work. We encounter savage meanness and we witness transcendence. We are confronted by family in their terrible and wonderful ways. We see that when there is everything to lose that choices narrow and love shows us the way. This is the crucible which makes the (wo)man.

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“Adam”: Making a life with Asperger’s Syndrome

“Adam” (2009, with Hugh Dancy and Rose Byrne; directed by Max Mayer)

Lloyd I. Sederer, M.D., written with Max Sederer, M.A.T.

Adam’s mother died when he was eight. He had the great fortune of having a loving and supportive father until he too died leaving this 20-something with Asperger’s Syndrome alone in life.  The neurological differences in people with Asperger’s Syndrome (defined as being on the more functional side of the Autism ‘Spectrum’) called for Adam receiving non-conventional educational services and social supports different from his peers – which his father had worked to provide him. Without his dad, he had no one, except for an avuncular friend of this dad’s who tries to coach Adam in how to succeed in everyday life.

That is no small task. Despite his high intelligence and remarkable memory, Adam, like many people with Asperger’s Syndrome, has serious impairments in his ability to read social cues.  He is limited because research suggests that when this type of information is sent along the nerve connections (synapses) in the brain it is compromised, resulting in difficulty with appreciating facial expressions, body language and tone of voice. Adam, additionally, has trouble seeing the full picture of what is going on around him: he not only misses seeing the woods through the trees, but the trees through the leaves. People, thus, with this condition develop interests which are often narrow and compulsively driven; for Adam it was astronomy and animals. Adam also suffers extreme anxiety associated with new and different experiences, a common symptom of Asperger’s Syndrome which can lead to seeking haven in a life of repetition or isolation.

Adam could only be accepted, not to mention find work and friends, in mainstream society when he learned to channel his special capabilities and train himself socially to exist successfully within a community of “neurotypicals” (that’s what we normals are called by people on the ‘spectrum.’)  But he was far from having done that when he is fired from his job as an engineer in an electronic toy company (a job his father found for him) because he could not make a 1000 toys for a dollar each, rather than produce one perfect toy that his boss told him would cost a thousand dollars and that no one could afford to buy.  Perfectionism is all too common within the AS community and often leads to difficulty with supervisors and peers in workplace settings.  Bereft of family and out of work Adam’s world is crashing around him and his intrinsically limited adaptive skills are stretched agonizingly thin.

That is where the love story of this movie begins. Beth, a writer of children’s books working as a school teacher, whose heart has been wounded but not broken, moves into his building. She is drawn to Adam’s innocence and honesty: he declares we (referring to people with Asperger’s) don’t lack imagination, we are just really honest. She is smitten by the wonder he can feel which brings simple joy and awe into her life. But she also has to contend with what has been called “mind blindness” where people with this disorder think that others think the same thing they do. That might be fine when shopping for clothing but it can wreck havoc with friendship, intimacy and sex.

The struggles of a person with Asperger’s Syndrome are painful and poignant. Like being a stranger in your own land.  There is little margin in everyday life to allow for the peculiarities that characterize Asperger’s and the understanding and patience it demands of others, despite the talent and loyalty that these special individuals bring to the party. When the soil, the community that surrounds them, is right – with understanding, appreciation, opportunity and patience – they bloom. That soil, that community, is us, the neurotypicals and those with Asperger’s Syndrome – in fact, everyone on the “human spectrum”.

The narrative of the story has Beth torn between her dysfunctional family and dysfunctional Adam. Her father tells her that “he is more like your child”, which indeed she only discovers when exigencies burst all their bubbles.  The dénouement is painful yet hopeful. Let’s grow up, the film resolves. “We go on, not back” lyrics in the score tell us. We see how love takes many forms – including when it transforms someone, when it fuels Adam, Beth or any of us, to take our life to its next maturational level. With love, we don’t just go on, we go to the light.

Max Sederer is Adult Services Program Manager of the Asperger’s Association of New England (AANE) and holds a Masters of Arts in Teaching. The opinions expressed herein are his and do not represent the views of the AANE. 

A version of this was published in the Huffington Post.

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The Blind Side

Previously published in the Huffington Post as “Resilience and Responsibility”

What if someone asked you: ‘Would you take a (black) homeless teenager into your home’? Not just for a night, but let’s start with that. ‘Whaddya mean?’ might be my response, as I backed away from the question.

But what if you knew this teenager, or someone you know well knows him? What if you knew his name, his school, his neighborhood, maybe even something about his family? What if he was not an abstract notion that tapped into all our fears of the stranger but rather a person with a name, like Michael, or Sean, or Ruben? And that you had room in your home and in your heart for someone whose future might be a bit different because of you, and that you too would be a bit different because of him?

Michael Lewis, who brought us tales of Wall Street (Liar’s Poker) and professional sports strategy by the numbers (Moneyball) also wrote a story about a 6’5” 330 pound teenager named Michael Oher who was born and raised in the Memphis projects – you could not dream up a name like Hurt Village but that it is what his neighborhood is called – to a mother who was an addict and a father whom he never knew. Lewis’ book, titled The Blind Side: Evolution of a Game (2007), is now popularized in a movie that carries the same though shorter title as the book The Blind Side; it has actors who draw an audience, like Sandra Bullock, Tim McGraw (of country music fame) and Oscar awardee Kathy Bates. So, this story has legs.

The tale is a feel good one where Michael Oher is taken in by a rich family (of Taco Bell fortune, the Tuohys) living in a designer mansion on the country club side of Memphis. The family that breaks the mold is Christian (and Republican) and are people both of privilege and with a sense of responsibility. The story takes a social and political issue and makes it personal.

But my commentary is more than a book or movie review, it is about the limits of government and entitlements, about resilience, and about what individuals acting as responsible agents can do to make communities and their lives better. Which is why the question of ‘would you take a (black) homeless teenager into your home?’ has more than one answer, depending on whether the answer is a dominant belief in government as the answer or an appreciation of how government can be most effective when matched by the problem solving energy of responsible citizens.

Government provides foster care for youth like Michael Oher. Without disparaging foster care providers, multiple placements with contracted care providers drives many like Michael to run, or to fail to flourish. One in four youth aging out of foster care in New York City become homeless, an illustration of a terrible national pattern. Many foster youth wind up in the youth correctional system, bringing with them histories of trauma and mental health and substance abuse problems in the great predominance of those admitted. Too often, those who become embroiled in corrections while young – those who survive the violence and drugs of their neighborhoods – become the adult occupants of our jails and prisons.

The Michael Oher story is remarkable; it also offers important insights into the limits of institutional responses to our basic need for belonging. While we need government to support social safety nets, we also need families and communities to redeem their neighborhoods and the lives in peril on every corner.

As important a question as is why do some youth go bad is why others, from the same circumstances and horror, find a way to make a life, to respond to hands that reach out to them? Resilience is what separates the survivors from the casualties. Physics tells us that resilience is a property, the capacity of some material to absorb energy and respond elastically so as to retain its integrity and not become deformed by the impact of the energy. The emotional equivalent is a person’s ability to absorb stress and not be broken by it. Michael Oher had resilience, and so do many more in Hurt Villages across this country and world. But resilience must be nurtured. After awhile, the material, human or otherwise, bends and breaks from the forces impacting it. People, not institutions, are what foster resilience. This is why individuals, families and communities, for their neighbors and those across the tracks, need to wonder ‘what can I do?’

In New Orleans and the Gulf Coast, over four years post-Katrina, communities there have truly seen the limits of government. They are of course reliant on government action to build strong levees, enforce sustainable environmental practices, and deliver the financial resources that families and businesses need to re-establish themselves.  But as Mary Rowe, director of the New Orleans Institute for Innovation and Resilience has said, “we are the ones we have been waiting for”. She is referring to urban farming, business development, experiential education, rebuilding homes – local efforts that connect people across race and class to reclaim and rebuild where they live and how they live. She is referring to the ecology of a community where mutual support breeds resilience and safety and health, where mutual support becomes the anodyne to defeat, despair, disease and violence. The Tuohys of The Blind Side also said, we are the ones who need to do something, something for this boy – named Michael, from their town, if not their neighborhood.

What can and must be done, beyond responsible and effectively run government programs, to create alternatives for those dependent on welfare, committed to foster care, and caught up in criminal justice systems in the central Brooklyns, Watts’, and Hurt Villages of this country? The answer, neighbor, is revealed in Lewis’ story, in the Gulf Coast, and in groups and communities willing to say, “we are the ones we have been waiting for.” These stories of resilience and responsibility seem to need retelling again and again to nurture the resilience and responsibility within us all.

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All so human: Where the wild things are

Published in the Huffington Post, October 2009

Over 40 years ago Maurice Sendak gave children and grownups a tale about a boy, family and fantasy that seems like it will last forever. With courageous creativity Spike Jonze has taken Sendak’s book and produced a visually astounding and psychologically turbulent film that warrants recognition in its own right.

The book story, known by heart by so many around the world, is about Max and his night with the wild things. The film has Max living with his self-absorbed teenage sister and divorced mother who is struggling to maintain a job, home and family, and have some romance in her lonely life. He is a boy “out of control” as his mother declares after countless episodes where he provokes trouble and then suffers its consequences. He is a boy like so many children today whose distress runs deep and reflects the agonies of our age: families on the edge, latch key children and communities that lack a sustaining center for their members. Max suffers the demons of loneliness, unbridled anger, sadness, and helplessness; these are the wild things of his emotions that he soon discovers follow him wherever he goes. What else could we expect from children (and adults and big furry and feathered creatures) when they are ignored, hurt and frightened? But he also has determination and hubris, a boy who builds forts and igloos and sails the seas of his fantasy to try to find a world where troubles can be mastered, even by little boys.

So Max runs away from the pain of his family, the brave captain of a sailboat that transports him under starry skies and across stormy waters until he happens upon an island inhabited by the wild things. There he discovers the same demons he fled but now embodied in these huge and expressive creatures whom he finds busy destroying their homes and each other and who greet Max with hostility and threats. But he stands up to them, and when they ask him if he can take away the loneliness he assures them he can, as well as sadness, for he has great powers. They declare him their king, and Max dons his crown with pride. He is no longer a mere boy but the ruler of the land of the wild things: let the rumpus begin!

Some movie reviewers I have read seem to regret how the film departs from the book and dedicates much of its time to portraying the individual and collective troubles of the wild things. They bicker, they fight, they pout, they complain, they yearn yet do little to satisfy their yearnings. They are all so human. They echo the existence Max has fled. He is the commander of this parallel universe and wearing the mantle of king he is called upon, as he promises, to fix it. I think this is where the film becomes a work of art of its own – no longer Sendak but Jonze and his collaborators taking us on what is a contemporary journey through the human condition.

What makes the film so memorable was that Max’s time as king was so revealing and instructive about us all. Max had no magic powers, no means of creating a happy thereafter. He was a modern king who confronted the complexity of troubled individuals and dysfunctional families. He tried to bring his kingdom happiness yet could only deliver a touch of relief, evanescent as it would be, only to be overtaken by the demons surfacing again as they do in ordinary life. But that made Max, and the film, all the more real, amidst its sumptuous imaginary setting. Yet, at the end of the film, everyone is just a little bit transformed. As a boy Max could see how his mother loved him and sacrificed for him; his mother could drink again from the loving forbearance she would need to sustain herself and thus be able to fall into restful sleep; and the wild things, well they were poised to try to wrestle with their demons and maybe trade kindness for meanness, and community for chaos. For the wonder of our lives is not about the ideal; it is about trying, forgiving, loving and bit by bit gaining perspective on who we are, and how we need to be. When a child and the wild things show us that, then we have been on a journey well worth taking.

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On Leadership: Invictus

Published in the Huffington Post, December 2009

Over a cup of afternoon tea, very British, the newly elected President of South Africa Nelson Mandela asks Francois Pienaar, the blond, handsome captain of the bumbling, losing South African rugby team, how he leads? The scene is from the movie “Invictus” about Mandela’s beginnings as the first black President of a country known for its racism, profound division and political oppression; he spent 27 years as a political prisoner, released in 1991 and elected to the nation’s highest office a mere three years later. He wants to unite the country’s 43 million citizens, including the white Afrikaners who fear retribution at the hands of the blacks who were dehumanized and unconscionably exploited by the state policy of apartheid – defeated but not dead in the hearts of its victims.

Pienaar responds, “by example” and Mandela wisely affirms his answer – but then takes the conversation to the level of his greatness. Mandela has decided upon a means to unite his country and build morale in the face of pervasive poverty, devalued currency, violence, and deep racial distrust; he wants to rid his country of what Churchill called “soul destroying hatred”. He thinks, despite his advisors, that by getting behind the national rugby team, traditionally symbolic of white culture that blacks cheered against, he will have a way of bridging the racial gulf. He wants the team to go from rugby goats to winners of the world championship, which will be held in Johannesburg in a year. Mandela needs the team to win, an outcome almost as improbable as his rise to power, and he needs to inspire Pienaar to the leadership that he will have to bring to the task.

Mandela muses about how others can inspire us, how each of us can go beyond ourselves. By rising above our self-perceived limitations we each can achieve personal greatness and thereby transform a culture – whether it is a sports team, a neighborhood, a small business, a large organization – public or private, or even a nation. The film then shows how the rugby captain and the team players discover, despite their complaints that they are overworked and overstressed (sound familiar?), that their capabilities are beyond their myopic estimation.

I am left to wonder, how do I bring out more in me of what I aspire to? How do I encourage, even inspire, remarkable capability in those with whom I work? How do we all exceed our expectations of ourselves, and others, so we harvest the abundance of resources that exists within all of us and thereby take our personal and professional achievements to levels we never imagined possible? Can it be a matter of perspective?

Two masons were cutting stone for a church when a traveler asked each what he was doing. One said “I am killing myself cutting this stone day after day”. The other said “I am building a place for people to find peace”. When Mandela was in prison, literally cutting stone in the blazing South African sun, he survived by finding, again and again, the path of holding his head high and regarding himself as “the master of my fate…the captain of my soul”. As a leader, he was able to inspire Pienaar, his followers, and even his ‘enemies’ to surprise themselves and become workers in building a nation that would transform itself with its unity, capability and forgiveness. Each one of us – personally and in our respective work and home communities – has the choice, decides, which mason’s vision in this parable we will embody. Each of us is the captain of our soul. It is not easy; sometimes it is really hard. But what choice do you make? We know what Pienaar and Mandela chose to do, and the rest is history.