A full transcript of every review is below…please scroll down to find it 

All reviews are by Dr. Lloyd Sederer

NEW TO THIS PAGE:

TV Series Review: House of Cards

Book Review: Back From the Brink

Movie Review: The Tightrope

Book Review: Quiet Dell

Book Review: Solo (James Bond)

Book Review: Tinderbox

Book Review: God’s Hotel

Book Review: Henry’s Demons

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BOOK REVIEWS

  • Back From The Brink
  • Quiet Dell
  • Solo – James Bond
  • The Gift of Adversity
  • Tinderbox
  • Man ALIVE!
  • God’s Hotel
  • Waiting for Sunrise
  • The Godfather’s Daughter
  • You Need Help!
  • Brain Based Parenting
  • 12 Patients: Life and Death at Bellevue Hospital
  • The Guardians
  • 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 and TV REVIEWS:

  • House of Cards
  • The Tightrope
  • The Fifth Estate (Everyone Lies)
  • Teach
  • Man of Steel
  • A Place At The Table
  • Promised Land
  • Lincoln
  • Middle of Nowhere
  • The Master
  • Take this Waltz
  • Moonrise Kingdom
  • OC-87: The Obsessive Compulsive, Major Depression, Bipolar, Asperger’s Movie
  • 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 

Back From The Brink: True Stories & Practical Help for Overcoming Depression and Bipolar Disorder

2013, New Harbinger Publications

By Graeme Cowan

When you open the cover of this book you first see a copy of a handwritten suicide note, penned by the author in 2004. The PS of the note reads “I just can’t be a burden any longer.”

Graeme Green’s (fourth) attempt on his life came after having endured an unrelenting five years of depression. He had lost his job, his marriage, his family home and was increasingly distanced from his children. The combination of seemingly inescapable psychic pain, a landscape of losses, and the end of hope had made death seem a desirable answer. His note thanked those that stood by him for their “loving care” and pleaded with them to not blame themselves; there was “…nothing possible that you could have done.”

People with mental illness have too few examples of those who have recovered and built a life with community, relationships, purpose and pride. Those with serious mental disorders, and addictions, who have built full and gratifying lives may not be visible. They may not broadcast their illness. They may be uncertain about their gains, fearful of stigma, or want to put the past behind them. They, and their families, need to know about others who have recovered, with illness, and built successful and meaningful lives.

Skip over the first section of this book, I think, because it does not give a full enough description to achieve the chapter title (Understanding Depression and Bipolar Disorder). That is a tough feat in 18 pages and might have been best left undone or rendered through words of first-hand experience of those affected by these conditions, rather than an attempt to summarize the causes and treatments of mood disorders.

Go right to the interviews with a wide range of people, famous or illustrative, that the author transcribes, which make up the predominance of the book.  Cowan asks many great questions that so many people impacted by mental illness have and may not dare to ask, or know whom to ask. “Did you sense that episode coming?” “Were you able to confide in anyone?” “How did your parents’ mental health issues impact the family?” “What was it that gave you hope?” “Was rehab helpful?” “When did you get to the point that you felt you needed to ask for help?” “Beyond medication, what else has been helpful?” “What gives you pleasure now?” “Looking back now, do you see any benefits of what you went through?” “If you could go back and give your{self}…advice, what would that be?” And many more questions specific to those portrayed in the book who were brave and put their problems, and solutions, out into the light of day.

Among his diverse group of interviewees are: Former US Representative Patrick Kennedy, son of Senator Ted Kennedy, nephew of JFK, and from a dynasty beleaguered by mental and addictive disorders; Trisha Goddard, with a TV and advocacy career in the UK and USA; the extraordinary Bob Boorstin, now public policy director at Google and former speechwriter to President Clinton and advisor to US Treasury and State Secretaries; Jennifer Hentz Moyer who gives us a clear view into postpartum psychosis and depression, and the path back; Alistair Campbell, a key member of Tony Blair’s administration for 10 years, from before and during the period that Blair was Prime Minister of the UK; as well as sports figures from tennis and professional football. These are amazing people who built or recovered lives with major mental illness. They show that recovery is possible.

Many common tools for recovery, for a life well lived, emerge from the interviews of this group of individuals. Principal among them are the critical need for support from people who care; good treatment delivered and adhered to over time; finding meaning and purpose through work or other endeavors; self-care with exercise, sleep and a healthy diet; staying away from alcohol and non-prescribed drugs; spiritual belief; and helping others. Those are prescriptions for all of us.

In the US, the Depression and Bipolar Support Alliance (DBSA), is an invaluable resource to people with these illnesses, and their families. An Afterword by Allen Doederlein , President of DBSA, nicely tops off this book about illnesses: he writes “…we don’t just talk about eradicating illness; we also talk about creating, maintaining, and celebrating wellness.”

For those searching for evidence of recovery from mental and addictive disorders – including those affected, their families and friends, and professionals serving them – you have them in Back From the Brink. Thanks to Graeme Cowan for giving us these stories.

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Quiet Dell

By Jayne Anne Phillips

“The law detects; grace alone conquers sin.” St. Augustine

I met Jayne Anne Phillips in 2009 when we were part of a small group of artists and scholars sponsored by the Rockefeller Foundation to work without everyday distractions for four weeks at their villa on Lake Como, Italy. She had begun writing Quiet Dell, an 80+ year old story that she has made the remarkable literary work it is today. In the evenings our small group would read or discuss what we were doing, and I got my first glimpse of the power, beauty and horror of this novel.

The story begins at Christmas, 1930. Jayne Anne Phillip starts by setting an elegant stage for the brutal events about to befall the Eicher family – a widowed mother, her three children, and Duty the dog – in the Chicago suburb of Park Ridge, Illinois. Each gloriously depicted, precious moment contrasts and foreshadows the agony and death this family will endure.

Quiet Dell is a love story embedded in a nightmare. The nightmare is the true tale of Harry F. Powers, age 45 (aka Cornelius O. Pierson and born Harm (sic) Drenth), a serial murderer who lured widowed and spinster women into his romantic death trap by letter writing through the American Friendship Society, an upright marriage agency and surely a predecessor to Match.com or e-Harmony; the Friendship Society advertised “…correspondence leading to true friendship, fidelity and matrimony.” The Eichers were one of at least two families he destroyed; evidence of others is only inferential, though at the time he had over 200 women with whom he corresponded with.

The principal romance is between a Chicago Tribune reporter dispatched to cover the murders and trial, Emily Thornhill, and a gentleman banker whose generosity and compassion were a kindness the Eicher family experienced after their deaths. But there are other harmonic love stories (an orphaned child, another reporter, Duty the dog) spawned in the wake of the horror. Goodness is the only antidote, the light that can lead us from darkness.

Anna Eicher was a 45 year old widow with escalating financial troubles. She was mother of Grethe (14 and developmentally delayed), Hart (12 and the ‘man’ of the family), and Annabel (9, a gifted, dreamy girl to whom the book is dedicated) when she became prey for Powers. He claimed to be a man of means and decency who would provide for her emotionally and give her family the security that death had robbed them of. The Eicher family is at the heart of this novel, but we also meet the family of Dorothy Lemke, a divorcee from Massachusetts, whose body was discovered when the Eichers were exhumed from their shallow, muddy graves. It was upon the evidence of the Lemke killing that Powers was tried, and convicted.

Quiet Dell is a West Virginia town, population 100, where Powers had property, a farm with a building he outfitted for his macabre pursuits. Fans of The Girl with the Dragon Tattoo will find the death chambers vaguely familiar, though surely more primitive. Jayne Anne Phillips, a native of W. Va., first heard the ghastly story of Quiet Dell from her mother, who as a child of six had walked past the scene of the crimes, holding her own mother’s hand.

Phillips brings deep familiarity to the ways of a rural small town, its people, its mores and its quiet desperation. Her writing has perfect pitch, with prose that often reads like poetry. The crime story may be ghastly and true but Phillips gives us hope in the ways she sustains humanity and by having life emerge from the ashes of hell.

As I read the book, which is highly visual in its depictions, I imagined it as a film. It would seem a treasure for a fine screenwriter. Powers plotting, the harrowing abduction of the Eicher family, the prison cellar at his “murder farm” outside of Quiet Dell, the brutal slayings, their discovery by the town sheriff along with a fifth body, and the outpouring of town rage are high drama. Powers’ trial, held in an Opera House (to accommodate the crowds) in the small city of Clarksburg, W. Va., near the town of Quiet Dell, will rival scenes of Hannibal Lecter facing justice and his sentence will slake a need for old testament righteousness. The moment when Duty, twice the survivor of families lost to disaster, is reconnected to murdered nine year old Annabel Eicher through her worn doll, Mrs. Pomeroy, will not leave a dry eye. The romantic scenes will breathe life amidst the deaths that anchor the tale.

Quiet Dell is a rare book. We readers are taken on a brilliant literary journey that passes through the netherworld but leaves us touched by grace.

……………

 Originally published in the Huffington Post, December 19, 2013. Copyright Dr. Lloyd Sederer

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Solo (Bond. James Bond)

A book review of SOLO, by William Boyd – in the Ian Fleming Tradition

Bond. James Bond. 007’s calling card – said declaratively, with a hint of menace, and of course with a clipped British accent. So began the Bond film legend with Dr. No (1962) with the inimitable Sean Connery fashioning a role that endures today through 24 trips into the dark and dangerous world of espionage that Ian Fleming created for us to vicariously relish.

Bond was no mere sodden, low profile spy. Thin stylish suits and ties, with dashing tuxedos for the casinos he frequented to play high stakes Baccarat, vodka martinis shaken-not-stirred, stunning women and villainous men, and the inscrutable M all heightened the fantasy that has fueled this remarkable franchise.

Ian Fleming wrote his first Bond novel, Casino Royale, in 1952. It was the 7th Bond actor, Daniel Craig, who breathed new life (and death of course!) into the first film version of this tale of 007 coming of age and and cutting his teeth with terrorists. Fleming himself was British gentry: schooled at Eton and Sandhurst (as was Churchill), son of a Member of Parliament, and a Naval Intelligence Officer so he was well qualified for the fiction he produced. He was a man, too, who smoked and drank with abandon and died twelve years after his first book from a heart attack at the early age of 56. Two of his Bond books were published posthumously but his work was too good, and too financially remunerative, a product to bury with its first raconteur.

And so, we have today a continuing industry not only of Bond films but Bond books, for readers and future movie goers. Where else will Daniel Craig, and his successors, derive the scripts for the wild movie going we all crave?

I was delighted when I read last year that William Boyd had been hired to write the next Bond book. Boyd is a terrific British storyteller (Waiting for Sunrise is one of his best – http://ps.psychiatryonline.org/article.aspx?articleID=1392923&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=PsychiatricServicesnowavailableonPsychiatryOnline12/04/2012) and the third writer in the Fleming forever franchise. He is the author of Solo.

It is 1969 and Bond is dispatched to a would be West African country divided by civil war. The spoils are oil and the Brits, though not them alone, want the war over since you can’t drill when there are guns going off on the surface of the massive, multibillion dollar petroleum fields. Bond’s 9 lives come in handy as does his resolve – driven by revenge – to give the story its narrative turns, pace and blood thirstiness. Solo refers to his going rogue in order to defy M and get the job done, once and for all.

The story is well stocked with a brutal bad guy, duplicitous mercenaries, a double agent (not 007), lies and more lies, injustices of all stripes, and corporate and governmental greed. In other words, it could be in the international section of the New York Times. But this is more fun since justice is served, not quite cold but in the fiery, yet cold blooded fashion that makes Bond the man who has riveted the attention of men, and women, for generations.

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The Gift of Adversity

The Unexpected Benefits of Life’s Difficulties, Setbacks, and Imperfections

Rosenthal, Norman E., Tarcher/Penguin, 2013

Imagine going on a lengthy walk with a wise man. You stride along with a person who over more than six decades has witnessed and experienced a range of trauma, disappointment, betrayal, loss and grief yet has emerged with the capacity to speak about adversity, and its value, through the gift of storytelling. Each day, as you proceed together, a short tale unfolds that portrays with clarity and warmth our human foibles and errors, and sometimes our inhumanity, yet without an ending tinged with demoralization or bitterness. The wise man’s stories aim to guide you, to help you find reconciliation with the flawed nature of – if not forgiveness with – the ephemera that is our life, to see a way of being that is not drained by anger, regret, remorse, shame, or revenge during our time on earth, during which no one is spared adversity.

Throughout 52 stories, a full deck, Dr. Norman Rosenthal is that wise man and this book is that walk. We are offered a memoir and a bundle of morality tales that follow, first, the arc of his life, then vignettes of his heroes and which concludes with his pondering about farewells. The good doctor begins with stories of his youth and then he advances to adulthood; as his life matures so do the stories he tells. The early ones are childlike (the section on “youth”) but then become more complex as they are enriched and leavened by the everyday, egregious ways in which we encounter adversity (the section on “adulthood”). Not one of us is spared limitations, failure, illness, trauma, or loss – not if we try, not if we feel. Rosenthal finds the silver lining, “the sweet uses of adversity”, again and again, to support, comfort and encourage his reader not only to be resilient but to defeat adversity by robbing it of its potential toxicity.

Dr. Rosenthal has a distinguished career as a physician and a writer. Born of Jewish, second generation, Lithuanian immigrants in Johannesburg, South Africa, he migrates with wife and young son to New York after medical school to take a psychiatric residency at Columbia and The New York State Psychiatric Institute at the dawn of the end of Apartheid. Over the years, he has worked at the National Institute of Mental Health (NIMH), headed a clinical trials company and treated countless patients with serious mental illnesses.

His psychiatric achievements are diverse and notable and include describing and developing light treatment for Seasonal Affective Disorder (SAD), a very common condition that drains people of energy and industry in the dark seasons of the year; the use of Botox for mood improvement, which illustrates how the body – in this case, facial muscles and expressions – affects the mind (a somatopsychic approach to medicine unlike the more typical psychosomatic views held in the Western world); research on the use of St. John’s Wort for mild to moderate depression; and how Transcendental Meditation (TM) can not only add calm, kindness and perspective to those fortunate to not have a mental illness but to serve, as well, a therapeutic role in conditions as troubling as bipolar disorder, the addictions and PTSD.

His books include Transcendence (about meditation and a NYT bestseller), Winter Blues (about SAD), and The Emotional Revolution. And now we have The Gift of Adversity. All are written for the general public in language and style that is eminently readable.

Each chapter of this book, each moral lesson, begins with a quote (or two) from other wise men and women throughout history and ends with his brief summary of what might be learned. The selection of quotes is wonderful and I thought, with his stories speaking for themselves, was sufficient so as to spare the reader a synopsis of its meaning. The stories themselves are rich and explore, among many other subjects, family, relationships, immigration, courage, work, history, education, service, science, teaching, research, psychopathy and discovery.

His own problems with depressed mood, especially in winter months, were instrumental to his discovery of SAD. His father’s wartime acquired PTSD opened his mind to understanding trauma, and how to make a life despite its residua. His near fatal attack as a young man by hoodlums (panga gangs) in Johannesburg was a lesson in danger and safety. Leaving home for residency and a career abroad taught him about family dislocation and renewal. Getting ousted from the NIMH after 20 years of success taught him about indifference, power and rebuilding.

His “heroes”, at least those he writes about, are his uncle who suffered a mortal wound in North Africa in WW II but did not die for days, during which he showed great grace and generosity; a cousin and childhood friend who was arrested by the Pretoria police in 1969 and tortured for weeks for his liberal ideas and friends, and who as an adult founded and has led a charity for victims of torture; his mother, who in her mid-70s, had the presence of mind to deter burglars known for not leaving their prey alive; and Viktor Frankl whose account of surviving Nazi concentration camps (Man’s Search for Meaning and other works) has served as a source for inspiration and meaning that never grows old.

His “farewells” are about death and dying; the loss of innocence; and living on after death. These are melancholic and sweet stories that are as familiar as they are profound.

Dr. Rosenthal pays particular homage to his father and uncle (the war hero mentioned above and to whom the book is dedicated). He uses memoir to make personal many of the moral lessons of the book’s first two sections. His credentials, so to speak, are being a Jew (history’s nomad, often its outcast) who lived with Apartheid, who grew up in the shadow of the Nazi Holocaust, who left his homeland, and whose career as a psychiatrist and researcher gave him the privilege of knowing and helping others manage madness and the consequences of human cruelty. But it is his gift for storytelling and his vault of experience, broad and deep, which allows him to look into the mirror of his own life – and that of his readers – and find what can be learned or appreciated, and discover how strength can be harvested from a lifetime’s crop of adversity.

Originally published in the Huffington Post on August 26, 2013

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Tinderbox

By Lisa Gornick, FSG, 2013

On August 5, 1949, a forest fire began in Mann Gulch, Montana. A group of “smokejumpers” (forest fire fighters who jumped from planes) were dispatched to the area. Intense heat and heavy winds ignited an inferno in which 13 died and only one smokejumper survived, Wag Dodge. Counter intuitively, unlike the others who died trying to outrun the blaze, Dodge started an “escape fire” around himself, which burned the tinder around him, the fire’s fuel, creating the space in which he was spared incineration, and lived to tell the tale.

In Peru in the 1890s, a rubber baron, Carlos Fizcarrald, portaged a steamship atop mountain terrain from one river to another hoping to make a fortune transporting its then precious cargo. The feat was memorialized, if not exaggerated, by the great film maker Werner Herzog in his 1982 epic, Fitzcarraldo, in which an actual steamer was dragged across land in the most inhospitable of environments.

These two stories, actually metaphors, are woven into and illustrative of the imagery of Lisa Gornick’s powerful novel. Fire, folly, and fortitude all play their part as a family is torn asunder, and it turns out they needed to be.

Myra Mendelson, PhD, leads a very well run life as a divorced mother of two adult children living on the upper west side of Manhattan, where she conducts her private practice of psychotherapy out of the brownstone she occupies. Everything is under control. But then she opens her home to her son who is lost in his too private and unsuccessful screenwriting career, his Moroccan Jewish doctor wife, and their 6 year old son who are all coming to NY for the wife to take additional medical training. This turn of events sweeps Myra’s daughter, professionally successful but personally damaged, thoroughly back into family life. But the spark that ignites the family is Eva, a Peruvian young woman, a nanny, whom Myra hires to help with her newly amassed household.

This is a family tale, one of loveless experiences, betrayals, divorce, traumas and deep dysfunction. Despite its sorrows, so brilliantly depicted in this novel, the story is, sadly, all too common. But were it not for the friction in this family, this “tinderbox” would not be set ablaze in order for us to see beneath a veil that is overgrown with convention and shrouded in secrecy.

Lisa Gornick is both a writer and a psychoanalyst. Her gifts for seeing beyond the surface, for appreciating and depicting the consequences of unrealized love and psychic pain, for observing with unblinking honesty the dynamics of family life and human foibles, come together in this novel, which starts off like a brush fire and then engulfs and burns with fury.

Myra’s ex-husband and son do not speak well for us men. But women, including her daughter, daughter-in-law and relatives, are not far behind in the dog house. I was concerned that we all would be tarred, even if deservedly so, until I realized that a knot must be made tight for it to be broken, a thicket must be made dense to bore through, and that only when pain becomes unbearable can any of us exit from everyday misery.

“The night is darkest just before the dawn.” So it is with a person, a family, before they find the light. When fire inevitably comes, it destroys – but it also burns away encrusted, twisted and dead wood. Fire furnishes the nutrients for new growth, for the vitality needed to make for new life, new love, and hope. That is the blessing that Lisa Gornick so wonderfully shows us in “Tinderbox.”

Originally pubished in the Huffington Post on 10 September 2013.

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Man ALIVE!

By Mary Kay Zuravleff, FSG, 2013

Dr. Owen Lerner was not unhappy. In fact, he was quite satisfied. A healthy man in his early 50s, he had a lovely wife with a successful career of her own and three prospering children, twin boys in name colleges and a loving daughter, an accomplished gymnast, in high school and living at home. But satisfied is banal as a state of mind when compared to a transcendent experience: the good doctor is electrically propelled by a bolt of lightning – as he inserts a quarter into a parking meter in a beach town that could be anywhere – into feeling, smelling and even tasting some sort of paradise. When you get to know bliss like that who wants to go back to the mundane? Not Dr. Lerner, who sets forth to sustain his rapture – to the chagrin of his family.

What’s Toni, his loving and overwhelmed wife to do? Owen is “…burned, broken and batty.” Like an ad for McDonald’s, Owen however, is basically saying “I’m lovin’ it!” But for her, what he feels as divine she thinks of as daft. It is months before he can walk unattended, no less get the scramble out of his thinking and words. Owen develops an extraordinary obsession, turned compulsion, with grilling! Not a Weber kettle or gas grille in the backyard for him; he has built a fire pit ample enough to roast a pig or half a cow. He spends endless hours on the Internet mastering cooking woods (red oak, wild cherry, hickory, mesquite and aromatic grapevines in case you suffer from the same disorder) and all forms of seasonings and rubs. He gets hold of a chicken coop, replete with chickens and a rooster. He walks around looking like a clown in spandex bicycle pants that cannot contain his expanding girth. The piece de resistance is when he gets a tattoo on his entire arm that replicates the burn pattern of the lightning, when that has faded away. Yet she is a dutiful wife who wants to stand by him in the many months she has been told it takes a person to recover from a lightning strike (if they recover…). This is easier said than done.

Dr. Lerner questions his work, doubts the value of his practice, especially the medication cocktails he expertly prescribed for “his kids” who were disabled with ADHD, Asperger’s and autism, OCD, PTSD, psychotic and other serious childhood psychiatric illnesses. He resumes work but only slowly because of his lengthy physical recuperation and his doubts about his mental functioning. In his office, he wonders if his destiny is in a barbecue pit rather than in the pit of childhood mental disorders.

All this threatens a long and strong marriage and portends bankruptcy as Owen’s income dwindles and his purchase of all things grilling (including hosting weekly neighborhood feasts) eats away at a budget already strained by the demands of an upper middle class lifestyle and two children in pricey schools.

Meanwhile, the children are not spared either. Brooke, the high school star, hooks up with the son of a Latin diplomat who exploits her innocence and abuses her. The younger twin, Rickie, at Duke, has been transformed yet in a way that has enabled him to emerge from his chrysalis but with an uncertain path ahead. The older twin, Will, at Penn, enters a depressive tailspin and explodes in a fit of rage that produces a darker storm than the one that struck his dad.

Yet it is son Will’s catastrophe that is catalytic, and turns the corner for the good doctor, and his family. But it is a corner turned, which is different from turning around. Owen, like Rip Van Winkle, begins to truly awaken, not only from his post-lighting delirium but from the semi-sleep that was his life before he was struck.  In a sustained, hilarious, tender and convincing conclusion to the journey she has taken the Lerners, and we readers, on, Mary Kay Zuravleff shows how we can never re-enter the same river in the same the water: the current (no pun intended) has produced new waters in the river of life.

Some readers will have seen The Descendants, a wonderful film about another family that is thrown for a loop by a crisis, namely the incipient death of the mother, who has secrets of her own. George Clooney starred and showed amazing range as an actor. I imagined Man ALIVE! as a movie, and hope it gets its chance. I would cast Paul Giamatti as Dr. Lerner; though it could be Tom Hanks, who can play anyone very well it seems; or maybe Kevin Spacey or Albert Brooks. Toni Lerner, his wife, would be an actor’s showcase for Helen Hunt (who in What Do Women Want? had a role as a love interest where lightning undid her beau’s charm rather than ignited it); or the role could go to Jodie Foster who knows how to be aggrieved and convey long standing suffering. Abigail Breslin (Little Miss Sunshine) is now old enough to play the daughter, Brooke. The boys, Ricky and Will, could be as dazzling a role as Armie Hammer had playing the Winkelvoss twins in The Social Network: what an opportunity for some young actor! The scenes and dialogue jump off the pages of this novel.

Man ALIVE! is electric. Open its pages or plug in your Kindle. I hope you will be as charged by it as I was.

Initially published in the Huffington Post on September 4, 2013.

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GOD’S HOTEL by Victoria Sweet

I bought God’s Hotel in 2012, when it was published, at the urging of a number of friends whose wisdom minds taking. But it went into a pile of good intentions to read, and sat there untended. Then some months ago I went to find it and it was gone! Without much detective work I discovered my wife had taken it to read and joined my other advisors in saying ‘you have to read this book!’

Now I can say I have. And its release as a paperback gives me the opportunity to write about this remarkable piece of creative non-fiction. I imagine its author, Dr. Victoria Sweet, would appreciate that it took time for me to journey to and through her work since that may be one of the many compelling messages she so eloquently, yet simply by storytelling, conveys: we’re all on a journey and when we see the way, value it and use it then we have found The Way.

There is an ancient pilgrimage, 1600 kilometers to walk, from south central France to the frontier of Spain and then due west to Compostella. In France the path is called le chemin and the route the Saint Jacques de Compostelle Pilgrimage. In Spain it is el camino and known as the Santiago de Compostella Pilgrimage. But the term that pilgrims for a thousand years have used is The Way. It is a journey of body and soul, a means of seeing, feeling and being that a person unleashes from within: this is a spiritual force, non-sectarian and universal, and a means of finding the purpose and human connection that are as essential to a life well lived as they are hard to achieve (Journey for Body and Soul – http://www.huffingtonpost.com/lloyd-i-sederer-md/journey-for-body-and-soul_b_666756.html).

Dr.  Sweet has walked the pilgrimage trail in Europe. And she walked it, as well, as a physician practicing in the very last of the alms houses in this country, The Laguna Honda Hospital in San Francisco, California. She committed to working there for two months and stayed twenty years. When she began Laguna Honda had 1178 patients whose medical conditions were so severe and persistent that there was no other place for them to go.

Terry, in her late 30s, had a bedsore on her back bigger than a dinner plate and had failed numerous grafts and needed “slow medicine” to heal.

Paul had amputations of both legs, finally at the hip, the result of clots that shut off circulation and produced gangrene, and needed slow medicine to rebuild a life in a wheelchair from which his skills with computers and bootlegging DVDs made him one of the more popular people in the hospital.

Radka, an older woman and immigrant from Bulgaria, had been sent from the County Hospital to die from lung cancer but she rallied with human warmth and slow medicine before she chose to go to hospice and then let go of life.

Steve, a former truck driver and present day pain in the ass, was thought to have had a stroke (and was not taking well to the idea of rehabiltation) until careful observation and critical thinking revealed he had a rare form of familial muscular dystrophy. He too was the beneficiary of slow medicine.

God’s Hotel abounds with stories of patients, and their caregivers, with all variety of chronic neurological, heart, lung and liver conditions, strokes, cancers, AIDS, and psychoses sent from acute care facilities to Laguna Honda for what might be a chance to find life again or to die with dignity.

Slow medicine does not disavow fast medicine: a broken bone still needs to be set, a heart attack kept from killing someone, and appendicitis requires surgery. But when acute care has done its job then recovery needs the right milieu, a different form of medicine, where the barriers to healing are removed, including unnecessary medications, abuse of drugs, alcohol and cigarettes, inadequate nutrition, and fear and hopelessness.

Dr. Sweet, also an historian of pre-modern medicine, wrote her Ph.D. while working at Laguna Honda. She studied the writings of a 12th Century German nun, Abbess, philosopher, writer, composer and medical practitioner named Hildegard of Bingen – a course of study which, like The Way, makes all the sense in the world once you read Dr. Sweet. Hildegard regarded the body as more like a plant than a machine and thus needed a way to reawaken its capacity for growth (greening or viriditas) rather than to be fixed like a machine (the metaphor of our industrial age). Hildegard’s work led Dr. Sweet to consider how to remove the barriers to recovery and fortify a person with the basics of healthy sleep, nutritious food, and protection from toxic substances and people while permitting “tincture of time” to also do its job.

The great irony expressed by the book (and sharply portrayed in Dr. Sweet’s TEDx talk The Efficiency of Inefficiencyhttp://www.youtube.com/watch?v=4w17dEDYrhE) is that slow medicine is actually efficient! Sometimes doing less is actually more, and it can save a lot of money. She takes to task consulting companies hired to update and improve medical facilities, politicians, myopic or ambitious administrators, and agonizingly entrenched or zealous government agencies and regulators that don’t know how to save themselves from themselves, no less the people they are charged with serving.

I may have missed God’s Hotel the first time around, but not this time. Nor should you if you want to feel hopeful that (and see how) modern medicine may come to realize that slow medicine can – and should – co-exist with fast medicine. Or as Dr. Francis Peabody of Harvard Medical School said in 1927, well after Hildegard of Bingen but true to her tradition: “The secret of the care of the patient is in caring for the patient.”

Originally published in The Huffington Post/AOL on July 22, 2013

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Waiting for Sunrise

William Boyd, HarperCollins, 2012

A young Englishman, Lysander Rief, a London actor before the outbreak of The Great War, has a sexual problem. He decides to go to Vienna for treatment, the epicenter of the “talking cure” – where Freud himself is both practicing and gathering apostles.

I thought early on in the book that it would be a coming of age story, with the help of psychoanalysis. Instead, Lysander’s very first consultation occasions a set of events you are not apt to encounter should you seek analysis. So begins this marvelous tale of intrigue, betrayal, romance and war.

Lysander’s troubles were minor league upon arriving in Vienna compared to the major fix he soon finds himself in, thanks in part to his recovered sexual prowess (only partly attributable to his treatment). His skill as an actor serves him well (but not on the stage) in Vienna, then London, then the French trenches, then Geneva (neutral in war but bursting with danger), and finally London again – for the denouement of his unsought after new career as a counter-espionage agent.

Waiting for Sunrise is the 17th book by William Boyd, a Brit who has joined great company in delivering spy stories. He has been selected by the James Bond – ‘007’ -estate to write the next in the series of Bond capers, due out in a year. His writing is tight and readily moves the reader through the plot twists this genre demands. Boyd opens this book by quoting Hemingway – “A thing is true at first light and a lie by noon” – heralding what lies ahead and foretelling the loss of innocence that our hero and the century past were about to suffer.

I am going to get another of his books to read. If you are a William Boyd fan, which would you suggest?

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Originally publised in the Journal of Psychiatric Services, December, 2012.

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The Godfather’s Daughter

By Rita Gigante, Hay House, 2012

The recent release of the film Anna Karenina has reminded many of Tolstoy’s wry comment: “All happy families are alike; each unhappy family is unhappy in its own way.” Little has changed in the over a century since it was penned: Each troubled family does seem to have its own signature disturbances. So it is for the infamous family whose tale is told in The Godfather’s Daughter.

Vincent (The Chin) Gigante was the head of the Genovese Mafia family, and by with that status he also was the boss of the five clans that ran the underworld of New York  – the Lucchese, Genovese, Gambino, Bonanno and Columbo families. He was also husband to Olympia and father of five children, named according to the ROSARY to reflect all their names: Roseanne, Olympia, Sal, Andrew, Rita and Yolanda. But that was just one of his two families, since he had a second, ongoing marriage to another woman (also named Olympia), with whom he had three more children. Of course they were Catholic, where divorce is anathema and I suppose so is murder.  But no matter, this is not a family that abides by the rules.

For decades, Rita’s father not only led this double family life he also pretended to have chronic schizophrenia, shuffling the streets of New York’s Greenwich Village (before it was trendy) in the same worn out bathrobe while muttering incoherently as he went from his hovel of an apartment on Sullivan Street, where he lived with his mother, to a “social club” nearby where he played cards with his friends and commanded a vast Mafioso empire.

We peer into this wildly dysfunctional family through the eyes of Rita Gigante, who gives us this memoir whose subtitle is An Unlikely Story of Love, Healing and Redemption. Rita lived in New Jersey with her mother and siblings; the other family lived in Manhattan. The Chin would visit New Jersey infrequently or she would have Sunday visits with him and “Gram” in New York City. Rita did not meet her half sibs until 1997, as an adult, when her father was finally brought to trial for extortion, racketeering, interstate conspiracy, violent crime, and first degree murder, among other charges. He was sentenced to prison and died there from heart failure at the age of 77, after having admitted feigning mental illness for all those years.

But that was just dad. Mother was a chronic depressive with frequent periods of withdrawal and on lots of psychiatric medications. Rita spent her youth under a cloud of depression, anxiety and panic attacks. She was a tomboy and given to violent outbursts herself, true to the powerful men in her family. Later she realized she is gay: now try to tell that to devout Catholic parents, never u mind that the father had violated about every major biblical injunction. How could he call another Catholic kettle black? Well, no one said the Gigante family code was built on logic or fairness. It was a family operating in an orbit removed from reason and amply endowed with the tools of deceit, pretense, and hypocrisy.

Yet Rita fashions, slowly, painfully, arduously, a life of her own. She is the beneficiary of lots of therapy, faith (not in the institution of the Church but in Jesus, Mary and the Holy Spirit), and a community of healers who practice massage, yoga, Reiki, herbal remedies, laying on of hands, spiritual counseling, and connection to other worlds (especially those who have left this earth, including her father). Rita finds the power of love: love with gay partners and love rediscovered with her mother and her family of origin, and finally – as the book details – reconciliation with her father before his death and all the more so after he passes.

Rita Gigante’s life surely was different, probably close to unique. Hers has been a journey of a “painted bird”, a bird of different colors as Jerzy Kosinksi portrayed (in a novel so titled), that was an alien ‘other’ to its own kin, an object of exclusion worthy of cruelty, yet who finds a way to evolve among other birds of a different feather in order to return to her family, where she can be both separate and the same. A Godfather’s Daughter has us join her on her path and her passions. You want to root for her, since her heart is big enough to forgive, not forget, and because she is a person who can find what bit of goodness exists, even in the most evil of men and the most troubled of families.

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You Need Help! By Mark S. Komrad, MD, Hazelden, 2012

Mark Komrad, MD, had a radio show in the 1990s called Konrad on Call, a call-in program about mental health. He starts this book by telling us the single most common question he received was “…my relative [sister/brother/wife/child/parent/friend] is clearly experiencing some real emotional problems. I think she needs psychiatric help. How can I broach the subject?”

“You Need Help” is his answer to that question. Since it is one of the most vexing of questions for families and friends, it needs answering. Dr. Komrad describes his book as “A step-by-step plan to convince a loved one to get counseling” – that is, how to convince someone to get help (treatment) for a mental (or addictive) disorder.

Much of the book readies the reader for his “how to” advice: there are chapters on getting involved, understanding mental health problems, and why mental illness goes untreated before he discusses what he regards the goal of help, namely getting an evaluation. Then his chapters address tactics, such as time, place, and allies, and offer clear advice illustrated by many dialogues that exemplify his points. He appreciates that people with serious mental illness may not yield to persuasion, which has him discuss moving from “…persuasion to coercion: and “how to play hardball.” Dr. Komrad writes that benevolence often underlies coercion, which he calls “compassionate paternalism,” and he gives examples of its success. While he mentions the risks of coercion, I thought he underestimated them.

There is a very medical orientation to this book, which as a psychiatrist I suppose I should support but I found it too narrow. Evaluations, very good ones, can and are routinely (and initially) done by well trained mental health professionals who are not psychiatrists. In addition, primary care physicians, school psychologists and social workers, and clergy (among others) play critical roles in evaluation and treatment, more so than you would take from the page or two of text they receive. And treatment, especially for serious or persistent mental illnesses, is done by multidisciplinary teams, often working in community or hospital clinics, generally not in individual doctor’s offices.

There are many roads to recovery (a term hardly noted in this book) from mental and addictive disorders. I wished that the readers had been given more information and clear support for a recovery orientation by Dr. Komrad, since it has come to dominate not just the world of addictions but the world of mental health as well. My surprise about the relative omission of recovery in this book was greater in that Former First Lady Rosalynn Carter (a champion for mental health and recovery since she chaired the first Presidential Commission on Mental Health in 1979) wrote the book’s Foreword. Medical psychiatry is still learning to harmonize with the recovery movement, and needs help to get there.

For readers in a hurry, the Appendix “Seven Steps for Convincing a Loved One to Get Help” is a good coaching tool, and it summarizes the chapters that precede it.

Families and friends face extraordinary challenges helping a loved one enter and remain in mental health treatment. They also will face a bewildering mental health system and terribly uneven quality of care. They need information, support and coaching. Dr. Komrad’s book can help.

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Dr. Sederer’s book for families who have a member with a mental illness, The Family Guide to Mental Health Care, will be published by WW Norton in the spring of 2013.

Originally Published in the Huffington Post/AOL on September 20, 2012

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Brain Based Parenting: The Neuroscience of Caregiving and Healthy Attachment

By – Daniel A Hughes and Jonathan Baylin, WW Norton, 2012

“Brain Based Parenting” is a long way from what we read decades ago when Dr. Spock (the pediatrician, not the Star Trek star) was explaining and guiding parents in how to care for their children. The distance is, however, principally in terms of understanding how the brain works – the neurobiology underlying attachment, attunement, and good and not so good parenting. That is the strength of this book and a remarkable strength it is.

Readers be warned: this book takes work. It takes careful reading, digesting complex material, and considering how we are both a product of our biology (and neurodevelopmental evolution) and how wecan influence our biology. The book is as much a textbook of neurobiology as it is a parenting manual.

The opening chapters are the most brain based, and perhaps the best. The reader will learn about key brain regions (the amygdala, hippocampus, insula, overall limbic system, and prefrontal/orbitofrontal/anteriocingulate cortices); mirror neurons; the vagus nerve, vegetative and autonomic nervous systems; and a host of neurotransmitters such as oxytocin (the attachment neurotransmitter), dopamine (the brain’s pleasure neurotransmitter), GABA, serotonin, adrenalin, and brain growth factors. This neuroscience course is tremendously aided by the authors’ use of summary boxes, graphics and photos. But it is not ‘neuroscience for dummies’; it is neuroscience for serious students of the brain, behavior and parenting.

Subsequent chapters get down to the business of parenting. They cover what the authors regard as the principal “domains” of effective parenting (approach, reward, child reading, meaning-making and parental executive functioning); “blocked care” (how parents are internally constrained from doing right); their formula for caregiving (PACE – playfulness, acceptance, curiosity and empathy); how parents can master their own emotional regulation; and “reflective functioning”, or how parents can feel and think, how parents can eschew judging and reacting and replace this with understanding.

This foundation in cognitive neuroscience is what I will remember the most from the book. I now can imagine what I can do to release oxytocin in my brain (give my wife or son or a dear friend a hug) or dopamine or how to prompt my cortex to override limbic fears and impulses and in so doing “be the adult in the room.” I can begin to appreciate how developing mindfulness and a meaningful mental narrative can avert powerful but not helpful defensive and reactive judgments, and how this will lead to being a more “attuned” and successful parent, or person in general.

To my surprise, the opening chapters (not the coaching that followed) were what left me the most enlightened. But I was forewarned by the authors, in Chapter 1, when they remarked that “…parenting is a brain thing.” The authors’ parental teaching and coaching was rather menu driven, even if sophisticated, clear and directive. But advice surrounds us and understanding is in short supply. The book’s contributions to understanding were what distinguish it. The book is not really a self help book but it does provide help.

There were many sections in the book on what happens between a therapist and a patient during psychotherapy. As a psychiatrist who has done a great deal of therapy I found these interesting. But they strayed from the core and critical topics of the book, namely cognitive neuroscience and parenting, which were in themselves enough to digest. I don’t comprehend what purpose this material will provide parents looking to learn.

“Brain Based Parenting” is one in a WW Norton series on Interpersonal Neurobiology, launched by Daniel J. Siegel, MD. Neuroscience and cognitive psychology are among the most exciting new fields about the brain and behavior in a long time. This book does sound justice to these subjects and to the evolving way that science can (and must) inform and assist everyday human endeavors, including, in this case, parenting. Is this book worth the wade into such complex territory? I say, stay with it and you will be rewarded, as will your progeny and the others that constitute your emotional world.

 Originally published in the Huffington Post/AOL on August 9, 2012

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Twelve Patients: Life and Death at Bellevue Hospital

By Eric Manheimer, MD – Grand Central Publishing 2012

Bellevue is one of eleven New York City public general hospitals. It is a municipal medical center that has cared for the City’s poor and ill for 275 years. It is also one of the world’s most famous hospitals. Not only is it our country’s oldest hospital, Bellevue also has a record of many firsts: first pediatric and maternity wards, first public health programs that were instrumental to controlling tuberculosis, typhoid and polio, the first cardiac pacemaker, and the first psychiatric hospital for children. Nobel prizes went to two Bellevue physicians for pioneering heart catheterization. Bellevue today has 380 psychiatric and substance use treatment beds which make for a large mental hospital in its own right within the walls of the massive general hospital. Bellevue also provides medical and psychiatric care to inmates transferred from Rikers Island (NYC’s 15,000 person jail) and boasts the busiest emergency department in the City, attracting every imaginable variety of trauma, physical disease, and psychic disturbance.

This history sets the stage for the twelve stories told by Dr. Eric Manheimer who was Bellevue’s Chief Medical Officer for almost fifteen years, departing recently to take on medical quality and safety projects at New York University/Langone Medical Center, Bellevue’s academic affiliate. Born in the Bronx, Manheimer trained in NYC but left for Dartmouth for 17 years, returning to enter the maw of municipal life and death, and demonstrating that you can take a boy out of the city, but not the city out of a boy.

Manheimer mixes medicine with anthropology, sociology, psychiatry and a bit of politics and economics. Yet the essence of what we read is how disease, person and circumstance converge and present the most daunting challenges to those who are ill, their families and the medical staff of this remarkable municipal hospital. Through the medium of stories he achieves a book that is more than about Bellevue: it is about people, families, caregivers, culture, communities, desperation, despair, resilience and hope.

There are stories about a fallen Wall Street titan; a gang member almost murdered at Rikers Island for squealing; about the horrors of domestic violence and random street crimes; on organ donation (Bellevue is a major center); psychotic street people; abused and traumatized children who live a life of emotional chaos, also known as PTSD; about the undocumented and uninsured who comprise a sizable proportion of the people served at Bellevue; and how heart disease, tuberculosis, parasitic people and conditions, drug abuse, mental illness, HIV-AIDS, poverty, and cancer are as much a part of New York as are its residents and visitors.

Manheimer himself is the subject of one of his stories. In 2008, Manheimer fell ill with squamous cell cancer of the throat, a bad disease. After thirty years of caring for others, he was now the patient. It was “three years of hell”, with radiation, chemotherapy and surgery – only to discover another cancer, melanoma, which itself can also be deadly. Remarkably, his treatment, his family and his indomitable spirit sustained him and he went back to work at Bellevue, before finally taking down his shingle as chief medical officer. This was a tough chapter to read, I can only imagine what it was like to write, no less live.

There is unsparing honesty in this book about medical care. For example, we get an uncensored look at medical errors, the cause of so many preventable hospital deaths. If it can go wrong it will, Manheimer reminds us. We see, also, how it takes leadership to contend with the resistance that powerfully and promptly coalesces when people and institutions are asked to do something different, even if it might mean saving lives. We also read about how doctors so often – expensively and futilely – chase after symptoms that have no physical basis since it can be so hard to imagine that the causes of the pain and suffering are psychic in nature. We confront, like the staff at Bellevue does every day, how the poor are the last in line in the food chain of medical care.

Manheimer has range as a doctor, a writer and a social commentator. This book is tough medicine. But nothing less is apt to work when it comes to curing that which is the hardest to treat, including our torn social fabric.

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 Originally published in the Huffington Post on July 11, 2012.

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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.

His loss is beyond measure to family and friends who loved him and relished his abundant talent, energy and quirkiness. Because his death was from suicide while in the throes of an acute psychotic illness, likely bipolar disorder, his death is yet another preventable tragedy.

In this country, 35,000 people annually succumb to death by their own doing; there are no doubt more where the cause of death is less clear. Each is a life that need not have ended and inestimable grief for those who held that person dear.

Sarah Manguso delivers a tightly-written, powerful “elegy” to her friend Harris. She wonders:

“Why is it easier to think ‘Harris killed himself’ than to think ‘Some unknown invasive pathology entered Harris without my knowledge and, while I wasn’t looking, murdered him?’”

She asks a question that plagues my field: psychiatry. She asks what is the disease that extracts the ultimate price from its host. By inference, she also asks how we can learn to protect against its invasion and, if not effective in doing that, at least avert a fatal outcome.

The Guardians, an allusion I imagine to the angels of antiquity who look after we mortals, weaves Harris’ and Maguso’s often tormented, creative paths — with his death seemingly to have permitted her escape from a similar fate. Manguso holds no animus to her friend for leaving her: She believes in “… the possibility of unendurable suffering.” At once darkening and heartening to their stories is also her depiction of the catastrophe that befell New York City on Sept. 11, 2001 — 9/11 brought horror, resilience and recovery to so many like them who lived through the attack.

Harris, who I never met, though I have known his father since medical school, was a spirited genius, a young man whose gift for creating music and computer software were head-turning. Scattered as he was, that did not matter; what counted was the way his remarkable brain operated and the ways by which he was a friend. Those were the treasures that Manguso enjoyed, and she dolefully laments their loss. We feel her pain since none of us is spared grief.

Serious mental illnesses can be agony: They are as painful as physical illnesses but further bedeviling because there is no broken bone, no dead heart or lung tissue, no cancer or non-functioning organ to point to. For some people with psychotic illness, their capacity to appreciate that they are ill has been pirated away by the “invasive pathology” that is mental illness. When intractable psychic pain seems like it will never end, without evident cause or hoped for remedy, the soul is taken over by a horrific state that Sartre called “no exit.” Those are the conditions that drive a person to suicide.

Harris deftly escaped the psychiatric hospital where he had been admitted. He may have been on medication that made his distress even greater, so speculates Manguso. There is so much we cannot know since he is not here to tell us what feelings and thoughts preceded his irrevocable act. But we do know that suicide is preventable. Manguso herself is a lesson in how life can go on, despite illness and tragedy; her path shows that love, creativity and contribution can be achieved.

Suicide is a public health problem. Like other mortal and disabling conditions there are fundamental ways to beat it. Solutions begin with early detection of mental illness: 50 percent of psychiatric disorders begin by age 14 and 75 percent by age 24. Even before that are the behavioral problems that occupy more often in pediatric practices than for any other reason that kids and families are in the waiting room. Yet gaps as long as nine years are typical from the time symptoms appear to when a diagnosis is made. Another basic, yet often unmet, public health principle is to assure the delivery of effective treatments; sadly, in this country, less than one in five affected individuals receive treatments — medications and psychotherapies — proven specific to their conditions.

We know that early intervention and evidence-based treatments can prevent the progression of a disabling psychiatric condition. Offering accessible services is also vital; clinics and offices need to be welcoming and responsive to patient and family preferences and without unbearable wait times to appointments, insurance hassles and denials. The role of hope, persistence despite setbacks, and exposure to and support from others who themselves have lived through the “noonday demon” (as Andrew Solomon described) can never be underestimated. Mental disorders are highly prevalent and can be treated. The pain and cost of not doing so, which is too often the case today, is egregious and exorbitant.

We have Sarah Manguso to thank for her revelatory candor and the beauty of her prose. We have her to thank for this tribute to her friend, whose loss cannot be reversed but whose story can impel a health and mental health care system to do better from here on in.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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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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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?

……………

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 (seeJourney 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 readDubus’ 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.


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

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MOVIE and TV REVIEWS

 

House of Cards: A Miniseries Review

“These violent delights have violent ends.

And in their triumph die, like fire and powder,

Which as they kiss consume.”

Romeo and Juliet

The second season of Netflix’s first adventure in a self-produced miniseries has just been released. Not one episode dribbled out with a weekly ration but the entire second season up for continuous viewing on our varied wireless and cable devices  – the only limits being the viewer’s appetite for this dark, fatalistic (but bloodless) tale of power as well as any human need for sleep or satisfying other natural functions.

House of Cards gave us, in season 1, Kevin Spacey as vengeful South Carolina US Congressional Democrat with a drawl, Robin Wright as his elegant and perhaps even more ‘take no prisoners’ wife, and Kate Mara as a lion cub reporter with grown up claws for what would be the Washington Post. They bounce off one another, and off other DC luminaries, like atoms in a nuclear reactor. There is heat, light, acceleration and destruction. There is also unmitigated, if hard won, joy. The joy of power.

I recall what I witnessed when I lived in DC some time ago. Unlike New York or Los Angeles or Dallas, where money, celebrity and even professional status prevail, it is power that makes for Beltway titans. The Honorable Francis Underwood, delivered by Spacey with just the right touch of evil, is both the perpetrator and a regular commentator, offering the audience brief sotto voce asides to translate DC culture and his command of it.

There seems little (if any?) redeeming value to the Congressman and his maneuvers. He is either making people pay, gaining control of others by exploiting their weaknesses or ambitions, or advancing his own might. Unlike West Wing, where we saw credible DC scenarios depicting a noble, socially progressive agenda, House of Cards is about the incessant striving to dominate, as if the ends had no real meaning.

My wife asked me why I watch House of Cards. Not that she has any problem with my attention to movies or miniseries; she is a regular herself. But why this show where no one seems to have virtue, or if they do they are soon to suffer as a result. A good question – especially since I am far from alone in looking forward to the next episode or season, late night fatigue notwithstanding.

Is there virtue in professional football play? There certainly is virtuosity. And a lot more viewers. The deft enactment of orchestrated power is a sight to behold, on the gridiron or the halls of Congress. A battle of titans fixes our attention and it is hard to divert from it. The finesse of power rendered without a trace of bodily injury, though with far deeper and often more intractable pain, is an enduring art form, even if only the province of a few.

Tragedy is the undercurrent, I think, of House of Cards: Tragic consequences to those sucked into the maw of power, the tragic cost to the multitudes whose lives depend on justice and the kindness of others, and the soul destroying that becomes the fate of those living on a diet of power and advantage. The Greeks knew tragedy. Shakespeare was one of its greatest portrait artists. Audiences amass to witness eyes gouged and kingdoms lost to vanity, greed and ambition.

There is nothing new in tragic stories. The opportunity lays when the canvas is blank and they can be painted in new and gripping ways. If you are looking for pain, dramatically portrayed with aplomb and irony, catch up with season one or start downloading and consuming season two of House of Cards. It is a tragic feast.

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Copyright Dr. Lloyd Sederer

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The Tightrope

How Do Actors Act?  A review of Peter Brook’s documentary film The Tightrope

How do they do it? How do (good) actors get us, the audience, to suspend belief – even recognition – of the person behind the actor’s mask so we can enter the different reality they have created?

You can have a rare look behind the curtains and the masks by watching Peter Brook conduct a master class, filmed by his son Simon using five hidden cameras to capture the experience without intruding. Brook was born in Britain in 1925 and launched his famous directorial career when a student at Oxford; he then joined The Royal Shakespeare Company (where he directed Olivier, Gielgud, Scofield and Kingsley) and a prolific list of plays and films. His career has spanned two nations, which have honored him with both The Order of the British Empire (1965) and Commandeur de la Légion d’honneur (2013). He is a living legend and going strong as he nears ninety.

In this documentary, Brook works with eight students of all nations and various ages in a large Persian carpeted room with little to draw attention away from the task at hand, which in his words is “…making theatre that is real, alive, that touches one…and does not let one go.” The class focuses especially on having the students walk an imaginary tightrope on the carpet. They do so in progressive stages of complexity: alone; with music (improvised with a hand drum or Asian string instrument, or with piano excerpts from Mozart’s The Magic Flute); with words; as pairs, triples and as a group in relation to each other; and with the license to follow their body’s imagination. Every second and every silence count. A group of actors, an ensemble of two or more, can only succeed when they become one, when energy and improvisation flow through all the participants.

We have moments with Brook, facing the camera off center but full visage, when he offers viewers a philosophy as much about life as it is about acting. We can go from “here to here” with élan but only by being completely alive – when we act (sic) as if we are on a tightrope escaping the chasm below only by utter attention yet at ease enough to allow inspiration to enter. He distinguishes the actor from the nonactor by the former’s capacity to imagine through the body (not the head). His notions of a play, for example, playing on words, go well beyond theatre and reminded me of the innocence of a child who delights in enacting what comes to mind unbounded by reality or convention – otherwise known as play.

The closing of a performed play, or our transitory existence for that matter, is not about it being the end, he remarks. What keeps the light burning is when an ending leaves a person or a group having a shared mind (even more than a shared experience). When actors achieve this they feel joy. Brook says we can witness success in theatre if just before the applause there is a moment of silence: that signifies that the actors and audience have touched one another, and want to go further. It is the endless trajectory of a mounting scale of “quality” that Brook believes delivers the gratifying experience of a play well done or a life well lived.

I had the opportunity to ask Glenn Close about her Oscar nominated role as the cross-dressing Dublin butler in the film Albert Nobbs (2011). You conveyed so much emotion and turmoil yet were so still in the role, how did you do it, I asked? She replied, genuinely, that “It was hard.” I had asked her a question that in many ways is ineffable, not unlike if someone asked me after decades of clinical practice how I did something quite right.

On another occasion, I asked Denzel Washington if Ruby Dee, who stole the show playing his mother in American Gangster (2005), was like his own mother as I tried to understand the electric and authentic intensity of their scenes together. With his million dollar smile, and I fear a tad of impatience with my innocence, he said, “Hey man, I was just acting.”

Ha! Just acting.

Where are the master classes, led by living forces the likes of Sir Peter Brook, for my profession (and many other callings)? Where does the tightrope lesson exist that demands (and guides) a keen balance between the science and art of medicine, navigating distance from and proximity to the troubles of others, attending both to what is objective and what is intuitive, and fostering the right blend of attentive listening and speaking out? Sign me up. I can still learn.

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Copyright Dr. Lloyd Sederer

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Everyone Lies: The Fifth Estate

A Movie Review by Dr. Lloyd Sederer

A gritty, staccato newsreel replete with many of history’s momentous events opens The Fifth Estate, portending the gravity of what’s to come. This précis also offers the transition from the ‘fourth estate’ (the media) to the film’s title, The Fifth Estate, where a handful of zealots can launch an information insurgency capable of toppling ruling institutions by revealing their secrets and cabals.

Gone are the good old days of the three estates, which date back to the Middle Ages, when church, nobility and commoners controlled the world. The fact that the fifth estate can leverage so much power through an able hacker, a decent server and some memory sticks (or even the Lady Gaga CD used by Private Bradley Manning to burn 700,000 documents) is a chilling thought. The disruptive fifth estate is the subject of this film about Julian Assange, the founder of WikiLeaks and the purveyor of Bradley’s information, who gained the world’s stage and the enmity of governments and media.

Assange’s method derives from Oscar Wilde who said, “Give {a man} … a mask, and he will tell you the truth”. As an accomplished hacker, practiced in this art since a youth, Assange learned to bury the identity of his sources so well that he gained a reputation for protecting them while blowing the lid off death squads, greedy banks, nuclear spills and governments that permitted such indecencies. It was years of his progressive taking down of miscreants that set the stage for the greatest leak in history, when in 2011 he released, without any redaction, all the US government files that Manning provided him. Manning recently was sentenced to 35 years of military prison, escaping a death penalty, and Assange remains in asylum in the Ecuadorian embassy in London.

Bill Condon (who directed Dreamgirls and two vampire Twilight Saga releases) fashions a suspense film with Assange at the center (Benedict Cumberbatch, whose credits include Star Trek, War Horse and The Hobbit) and Daniel Berg at his side (Daniel Bruehl, whom we recognize for his roles in Inglourious Basterds and The Bourne Ultimatum), with state department officials (Laura Linney and Stanley Tucci) among their arch enemies. In other words, brace yourself for intensity.

The high drama of the film too often distracted from the plot. Did we really need figurative fires, shattered screens and desks, boy-girl tensions, and yet another battle of keyboards that was done so well a long time ago by Harrison Ford in a Tom Clancy film? The story is dense and takes careful telling. But it is monumental story that could stand on its own.

There is an arc, it appears, to the career of a leaker, a fifth estate revolutionary. Youthful idealism, fueled by a troubled and oppressed childhood, initially may have driven Assange; but as purpose and success grow so does his megalomania. Assange’s war on the United States had him willing to reveal identities of operatives around the world, exposing them and their families to murder, the United States and its allies to terrorism, and career ending consequences for patriots after a lifetime of service.  The man and his mission became inseparable. His accomplices turn against him. It is increasingly his own narcissism that sustains him.

Assange is not a likable person. Does that matter? What do we, as witnesses to this information war, need to take a side? What is the moral ground a leader must occupy that helps to put character in the background while quest takes the foreground? Is it not honesty? Integrity? Respect for the lives of others? Here is where my sensibilities abandoned Assange, as it did his closest allies. He lied, he manipulated, and he bathed in the glory.

Everyone lied, and Assange was really good at revealing their lies. But he lied too. We judge a person’s actions not only by what he does but also how he goes about it. Will Assange be exonerated in the court of public opinion for taking whatever actions he thought he needed to win his war? Assange thinks we will conclude he is a hero. But he thinks too much of himself.

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 Originally published in the Huffington Post on October 17, 2013

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TEACH

A Participant Media Documentary and Campaign

Lloyd I. Sederer, MD

Max Sederer, Masters of Arts in Teaching (M.A.T.)

“Tell me and I forget, teach me and I may remember, involve me and I learn.”

Benjamin Franklin

Teach is a 90 minute documentary developed by Participant Media (Company with a Conscience, http://www.huffingtonpost.com/lloyd-i-sederer-md/company-with-a-conscience_b_854598.html). It aired in early September on CBS network TV, and continues on Participant’s new cable station, Pivot; it is accompanied by an 18 month program of screenings and conversations around the country in high schools, colleges, and community organizations, with a special effort to involve African American and Hispanic communities.

In Teach, we enter the lives of four teachers, Joel, Lindsay, Matt and Shelby, and their classrooms of struggling youth across a diverse range of ages and racial and ethnic backgrounds. What the students have in common is limited reading, writing and math skills, poverty, and families where no one went to college and many could not graduate high school. Each of these four teachers is an impassioned 20-something professional with the kind of heart and dedication that makes you want to cheer them on.

But there are reasons that 50% of public school teachers leave the profession within five years. In fact, one of the authors of this article (MS) became part of that 50% after completing a Masters at Tuft’s University. The other author (LIS), his father, recalls when his son called and said he was leaving teaching, less than five years after completing his training.

In Teach, we witness how unstinting effort on the part of these teachers produced results that either advanced their students to grade level (from being behind) or outperformed comparable schools in their district. It was not only the students who felt inadequate; it also was their teachers – who themselves needed to be supported and taught by mentors and supervisors. You will forgive teachers, I think, for being self-admitted “control freaks” when you observe all they need to master and manage.

360° math was a great example of how teaching can be advanced by putting the students at the center of the universe – of making the teacher the audience rather than a conventional model where an educator talks to or at students. The value of teachers themselves modeling behavior, as well, by putting themselves personally into the work showed that doing more makes a priceless difference.

But let’s look at the 50% drop out rate at 5 years. Why did Max Sederer, and so many others, leave teaching for other careers? It was not from lack of passion, hard work or commitment, his dad can say and I think he would agree. But when results are not forthcoming then these virtues are hard to sustain.

Imagine getting up at 5 or 6 AM after having stayed late at school the day before and done lesson planning into the evening. You are ready to go but what about your students? Some cannot concentrate because they are hungry or because of the serious dysfunction at home. Some have undetected major learning or mental disorders. Some, in high school, come high on drugs or have the residual blood levels that marijuana and opiates produce when taken the day or days before. Some carry weapons or would if there were not metal detectors at the school. Of course, we are not talking about public schools in prosperous neighborhoods but they are the exception not the rule.

Add to this the salaries that our teachers are paid. For all the importance we attribute to them their pay is not commensurate with their role in our society. There are many better paying jobs for talented youth with graduate degrees, even in our poor economy.

All this is not meant to be a defeatist polemic but rather a call for even more that needs to be done.

Let’s start with families. Let’s find ways, as some amazing programs like The Incredible Years (http://incredibleyears.com/) and About Our Kids (http://www.aboutourkids.org/) have shown, that train and support families so their children can learn in school. The earlier the better: start with preschool and continue from there.

Let’s raise the status and earnings of teachers so that the ones we see in Teach are not recruited away.

Let’s find ways to reduce the inefficiencies and absurdities that plague school administration so that teachers can teach, untarnished by the politics of education in their communities and states.

And let’s credit Teach.org (https://www.teach.org/) the group that Participant Media has recognized as offering the vision and resources to assist young people pursue careers in education, and to remain there to make a difference.

We hope you will view Teach, and that you too will be reminded of your story about a teacher who inspired you and showed you the light. We hope that the campaign begun on TV and across the country, with the support of the celebrities the documentary portrays and the communities that advance the effort, will be further impetus for innovation and relentless battle against the status quo.

One of the students in Teach, one who even did not make her goal of advance placement, said a teacher is “…someone who inspires you.” Inspiration is a powerful antidote to pessimism and paralysis. That’s how the light gets in, said Leonard Cohen.

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Dr. Sederer’s new book for families who have a member with a mental illness, The Family Guide to Mental Health Care (Foreword by Glenn Close) is now available. The opinions expressed here are solely his as a psychiatrist and public health advocate. He receives no support from any pharmaceutical or device company. http://www.askdrlloyd.com

Max Sederer is a Disability Specialist at Northeastern University and holds a Masters of Arts in Teaching. The opinions expressed herein are his and do not represent the views of Northeastern University.

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This review first appeared in the Huffington Post on October 9, 2013.

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Man of Steel: Superman past and present

It was the 1950s: ‘I like Ike’, peace, post-war prosperity, and families that appeared, at least on the surface, as All American. Television, though still new, had taken over our culture, capturing the attention of our country, me no exception.

I had my favorite TV shows but at the top of the list was Superman. “Faster than a speeding bullet, more powerful than a locomotive (hmm, not very fast or formidable nowadays), able to leap tall buildings with a single bound” began each episode as I lay on the carpeted floor of our home on Eastchester Road in the Bronx as close to the small screen as I could so as to be swallowed up by the tale that would unfold. Year after year I watched George Reeves in his padded costume stand for good and embody what every boy would want – unbridled strength, a pretty girl, and the opportunity to fight evil, unfailingly, week after week, without revealing his identity, which was often the mockery of others – hah, if they only knew.

It should come as no surprise, therefore, that I have seen every Superman movie, some many times. And that I would have to hit the multiplex upon release of Man of Steel – not to mention see it in its full glory, namely 3D. I was amply rewarded by Man of Steel with its story, its fulsome acting by a star spangled cast, and even – despite my vintage – its astounding computerized effects that took you to galaxies of action in outer space and inner cities, where density amplifies the destructive experience.

There are two stories that unfold in Man of Steel. One is on Krypton, Superman’s native planet, and one on Earth, where he has acclimated to our atmosphere and the American way of life. On Krypton, the story is about Superman’s parents (Russell Crowe acquits his reputation for bad behavior by being an exemplar for the values of his planet and the father of Superman) and a planet that ceased to have natural births and exhausted its supply of energy by violating the rules of nature so as to bring upon itself its cataclysmic end. The other is on Earth, where Superman (played by a series of child actors and as an adult by an amazingly blue eyed, physically cut and super determined Henry Cavill) is the child of Diane Lane and Kevin Costner, who fit their roles as shapely as does Cavill fill the Superman uniform, which in his case needs no padding. He is raised not only with mid-western values but also is taught that some day he will have the chance (that is, the responsibility) to shape the character of all earthlings, something we can imagine will be a pretty tough task to fulfill. He has to put up with bullying to not reveal his identity while not missing a beat and saving those who could perish from any number of unforeseeable events. He has to keep his powder dry, especially the explosiveness of who he is, until the world may be ready and able to accept it.

Lois Lane is played by Amy Adams, who is as versatile an actor as she is the embodiment of sweetness, intelligence and let no person get between her and her story, or compromise her virtues as a journalist. Laurence Fishburne is Perry White, the tough but always decent editor-in-chief of the Daily Planet. And continuing his run of dazzling performances is Michael Shannon as General Zod, the born and bred military zealot who lives, and dies, to protect the citizens of Krypton, no matter what anyone may think of whatever means are needed to achieve this end. In other words, this ensemble of actors is as good as they get and they do not disappoint – on this or any other planet.

Mayhem is the mode for the last hour of this 2 ½ hour spectacle. But there are still moments when the souls of the characters shine through, when romance is kindled, and when we humans distinguish ourselves for the depth of our morals that may, hopefully, save us from ourselves as we face not just desperate characters from Krypton but the greed, corruption, neglect of others and the environment, and broken bureaucracies that threaten decency and compassion, not to mention the fate of our children and grandchildren.

Yet, as much as I left the theater feeling satisfied, that my time and money were well spent, I thought that this is not what it takes to shape the budding personality of youth. Movies like Man of Steel, even with its sequels, are transient; they are ephemera, quick hits to our psyche. I don’t think that this movie, or virtually any series (except maybe Harry Potter and The Lord of the Rings), can nourish a maturing mind (not that “Man of Steel” means to). I don’t think that the youth who watch this film today, or even the grey hairs like me, can experience the necessary repetitive exposure to a story line that shows, again and again, human strengths beyond the physical, a superlative moral icon to identify with, and a cast who demonstrate that saving earth is a team sport.

All that takes time – more than a night at the movies: time to be enraptured and then slowly filled with the wonder of our humanity, our foibles, and our capacity for resilience, determination, and love. That’s what steel is about, I learned a long time ago. That’s what I want to deliver today as a mere mortal who likes sometimes to think that under his shirt and tie is the letter “S”, and it doesn’t stand for Sederer.

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Originally published in the Huffington Post/AOL on June 17, 2013.

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From Up On High: A Place At The Table

From up on high, as the helicopter cameras open this documentary film, peering down on amber fields of grain, from sea to shining sea, the United States appears prosperous, abundant in its produce, rich in its plentitude of space and foodstuffs. T. Bone Burnett’s music soars adding to the grandeur. But this is all a trope, setting the viewer up for a ‘take down’, where we are built up only to fall all the harder.

And not without good reason: for 50 million Americans, children, adults and the elderly, are now hungry, uncertain about having food to carry them through the day or the week ahead. Presidents as divergent in their politics as Reagan, Bush I and II, Clinton and Obama have foresworn to end hunger; yet each has presided over an unceasing rise in hunger with five times as many Americans today going hungry as there were in the 1970s.

Upon descending from up on high, A Place At The Table enters the grinding lives of Rosie (a 5th grader) and her teacher Leslie Nichols (who in childhood also knew hunger) from Collbran, Colorado, where small town life nestled beneath the awesome Rockies is rife with unemployment, unlivable wages, and hunger; Barbie, a 20 year old single mother of two in Philadelphia whose young son is already experiencing the developmental delays that disproportionately strike nutritionally compromised children living in urban chaos and poverty; Tremonica, a second grader already obese and unhealthy whose family lives in Jonestown, Mississippi, a state that gets the prize for ranking at the bottom of all 50  in food insecurity (a term referring to being uncertain about having or obtaining enough food to meet the needs of a household); and examines unblinkingly a full time, town police officer who has to go to food pantries to feed his family, a rancher who works nights as a school janitor to put food on the table, and a cook in rural Mississippi who must drive 45 minutes to find a green grocer (and spends over $10 in gas) .

The ironies abound in this lean 84 minute documentary. Obesity in this country is shown to be often a sign of hunger and poverty, unlike in very poor, developing countries where hunger and poverty leave people all skin and bones. Becoming employed, as did Barbie after a year of trying, left her unable to feed her family because she earned less than a living wage – though she no longer qualified for the Supplemental Nutritional Assistance Program (food stamps).  Seventy percent (70%) of Federal agricultural subsidies go to 10% of US farmers: not the family farms that gave rise to this support in the crippling depression of the 1930s but to the corporate agribusinesses that dominate farming today.  These subsidies sustain the massive production of corn, wheat and soy used to make affordable (cheap) processed foods, such as chips, cookies and cakes, candies, and high starch (and salted) foods like bread and many pastas. Since the early 1980s, the costs of processed foods have dropped by 40% while the costs of fruits and vegetables have increased 40%. Even if poor families were to try to buy healthier foods they frequently live in “food deserts”, vast swatches of rural and (even more so) urban communities, where stores shelves burst with processed foods and not an apple or head of lettuce is to be seen.

The consequences of hunger are far greater than the pain and malaise that comes with an empty stomach. A hungry child cannot pay attention in school. Nutritional deficiencies in a mother carrying a child and in the early years of life produce delays in brain development, leading to impairments in learning and behavioral disorders and to children being left behind. One in 3 children entering their teens today will develop Type 2 Diabetes. Obesity, in time, increases the risk of hypertension, heart disease and stroke, and puts more strain on our joints leading to osteoarthritis and mobility problems.

A Place At The Table is another socially focused film by Participant Media, which has produced documentaries such as An Inconvenient Truth, Food, Inc. and Waiting for “Superman,” as well as fictional stories, including Contagion and The Help, with unsparingly honest views on contemporary issues.

The message in this documentary is that hunger in this country is not about lack of a sufficient food supply – we have ample stores of grain. Hunger is about the denial of adequate and nutritious food to families living in poverty, whether on our great plains or occupying our inner cities. We witness the evidence in the film’s stories of these families; from spokespeople like Congressman James McGovern (U.S. Representative, Massachusetts, Co-Chair, Congressional Hunger Center) to actor Jeff Bridges (Founder of End Hunger Network); and from experts and doctors who have documented hunger in America and treated its consequences (see some examples below).

I left the theatre feeling empty, not really hungry. But I went home and made myself a salad of pricey Whole Food greens with virgin olive oil and some low fat nuts. I have the good fortune of living in an oasis of healthy food abundance, and an income to purchase nutritious food to help keep healthy. There will be those who criticize this film for promoting government programs or encouraging dependency among people living in poverty in this country. I suspect these critics will not have experienced uncertainty about where their next meal will come from or how “hunger messes with you” in the words of one young girl in A Place At The Table.

For more on hunger, see:

Raj Patel: Stuffed and Starved

Janet Poppendieck: Free for All; Fixing School Food in America

Marion Nestle: Food Politics

J. Larry Brown: Living Hungry in America

Barbara Ehrenreich: Nickel and Dimed

Knut Hamsun: Hunger

Originally published in the Huffington Post/AOL on February 28, 2013.

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Promised Land

As a psychiatrist I don’t know much about gas fracking but I have learned some things about human nature, including how the conscience – even if temporarily contained – will, in time, have its moment of reckoning. How that happens for Steve Butler, the ‘All American’ advance man for a global energy company is the human story of this remarkable film.

Promised Land was tightly written by Matt Damon and John Krasinski (who co-stars in the film as a tree hugger ostensibly having come to a quiet, desperate farming town sitting on top of a fortune since gas is as good as gold) from a story by Dave Eggers. The movie is yet another of Participant Media’s co-productions; they are a company that knows how to get behind a broad range of social issues (http://www.huffingtonpost.com/lloyd-i-sederer-md/company-with-a-conscience_b_854598.html; some of their other films include The Help, Contagion, Lincoln and The Soloist).

An ambitious, affable Steve Butler (the ubiquitous Damon) arrives in a rural Anytown, USA, here called McKinley,  whose fortunes have seen far better days, with his veteran partner, Sue Thompson (played with aplomb by Frances McDormand). They are there to convince the townsfolk to lease for fracking their bucolic pastures to a corporate behemoth. Might as well call the town David and the multinational Goliath since how can this town and its ordinary people, who do manual work, drink and sense that generations of their earnest work is about to reach its dead end, stand a chance?

Mr. Damon, as Butler, has shown us how well he can morph into so many a character, especially the kid next door whether he is a rogue agent, or from a working class Massachusetts town, or a farm boy from the mid-west. In Promised Land he had grown up on a farm but become a city boy hungry to leave his past behind. It is his familiarity, his insider-ness to the town’s people and culture, that allows him to walk right in, to fit right in, and to bypass their defenses against  strangers from another, avaricious world. Dustin Noble (Mr. Krasinksi, charmingly infamous from The Office) arrives on Butler’s tail driving a pick-up bearing the decal of an environmental advocacy organization and loaded with lawn signs depicting the toxic death of cows and perhaps other mammals, like, um, humans. Bad guy Butler, good guy Noble, you might think; let the battle begin.

Romance sweetens the story as Steve Butler meets Alice (Rosemarie DeWitt, a growing presence in film, TV and stage) a McKinley elementary school teacher who proudly peers over the land she inherited upon her father’s premature death. The competition between Butler and Noble intensifies as both court this local belle. She is more than a romantic interest, however, because she embodies the values that run deep in this town and in good people everywhere.

For the film’s Dumbledore or Gandalf we have Frank Yates (played by Hal Holbrook, a specialist in iconic characters) who came home to McKinley to teach science after MIT and a career in the aeronautics industry, so he is no simple beaker stirrer. He is the voice that admonishes the townsfolk about the risks they may incur from fracking and proffers to Butler that a life without dignity is no life at all.

What rang true to me, wearing my day job hat, was that neither the romantic sway nor the moral argument was what was transformative for Butler. Mind you, they likely softened him up. What clinched his change of mind, and his redemption, was how he was humbled, beaten, at his own game. To see how he was fracked, so to speak, you will need to see the film because I will not spoil that fine piece of writing and acting.

Promised Land was done on a low budget ($15 million) yet feels like a far more pricey production. Its release, evidently, will be accompanied by a counter-media campaign by those who seek to frack pristine, ailing communities and promise prosperity instead of food stamps, and all of us freedom from foreign oil.

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Lincoln – A timeless tale of fighting inequity

I screened Steven Spielberg’s, Lincoln, an epic biography of a man, politics, a nation at war, and the timeless battle to dismantle the structures of inequity less than a day after Barack Obama was reelected President of the United States of America. The two Presidents, separated in time but not mission, have faced and fought entrenched interests that violate the principle of “all men are created equal.” While Abraham Lincoln opened the door for a black man to eventually become president of this country, then unimaginable, his victory did not end the battle for equality he so ably fought, and for which, he too, “…laid so costly a sacrifice upon the altar of freedom.”

Lincoln, the film, gives us a thin wedge of American history during the Civil War, leading to the passage of the 13th Amendment (abolishing slavery) and concluding with the President being declared dead by his Army Surgeon surrounded by his Team of Rivals (the Doris Kearns Goodwin book credited as a principal source for the story). This short slice of time allows for a detailed and intricate tale to be told, one that is ultimately kind to the folly of the ways of government and the men (then) who rule. Government, especially democracy, is messy and tainted by human faults, yet can rise to the lofty aims it so declares when brilliantly and unrelentingly lead by individuals who by character and circumstance find a way to realize the decreed ends for which they have been selected to achieve.

Our nation is split, a civil war rages, then and now:  in the 1860s it was on bloody battlefields, between northern and southern states, and within a Union Congress; today the battle is blessedly non-violent yet creating great rents in the fabric of our society and among its political and governing bodies. Obama wins the general election but the day after we realize that his two year fight to do so leaves him facing the same resolute opposition and shameless polemics that have commanded the airwaves since before his first election. He too will have to use methods virtuous and crafty, make deals and deliver favors, and put himself personally into the fight, as did Lincoln to win the final votes necessary to pass the 13th Amendment. It’s not pretty but it gets the job done. Lincoln himself said, in a eulogy he gave on Zachary Taylor (who died of natural causes as President in 1850): “The Presidency, even to the most experienced politicians, is no bed of roses; and Gen. Taylor like others, found thorns within it. No human being can fill that station and escape censure.”

Some focus on Lincoln as a melancholic, as indeed it seems he was. Perhaps this condition added to his great empathy and his resolve in contesting hopelessness; perhaps it was instrumental to the ways he learned to bear pain and fight the good fight. But melancholia is not a precondition for sainthood nor the only cross that is borne on the way to greatness. The film unsparingly shows us Lincoln’s grief and loneliness but makes no claim to its causes.

Daniel Day- Lewis, who gave us Hawkeye in The Last of the Mohicans and Daniel Plainview in There Will Be Blood (for which no one else could possibly compete for that year’s best actor Academy Award), among other indelible roles, delivers a Lincoln robust in prairie wisdom and cunning, bathroom humor, and bottomless suffering; this itself is a feat to behold. Much is being said of his high pitched rendition of Lincoln’s voice, all deservedly positive for the credibility it conveys. Day-Lewis has a team of rivals himself, who strengthen his thespian cause: Sally Field, tiny yet grand in her power, is Mary Todd Lincoln; David Strathairn, aristocratic and admiringly decent, is William Seward who Lincoln defeated at the 1860 Republican Convention and then named Secretary of State (as did Lincoln name all the other rivals to his Cabinet!); Tommy Lee Jones is the Congressional curmudgeon Chair of Ways and Means and a man who fought a lifetime for abolition (as you will understand better after you see the film); and others, young and old, who populate the complex human tapestry of this film.

Why does Lincoln never get dated? Why can his story be told again and again, and never seem to wear out its welcome? I think it has something to do with how visceral our needs are for equality, equity in opportunity, justice and dignity. I think it has something to do with seeing one of our own, deeply human and without pretense or self-interest, honor what is noble and let no obstacle stand in its way. That he paid the ultimate sacrifice adds tears to his achievements. May our current President win his battles for equity without war or personal sacrifice and lead us to a stronger union.

This review originally appeared in the Huffington Post/AOL on November 9, 2012.

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Middle of Nowhere

Middle of Nowhere is beautifully drawn and poetically written. It teaches about family, race, character and the often unknowable arc of a life, without becoming pedantic or pretending to have answers.

The film opens in the middle of nowhere, setting the tone, as a bus arrives at a high security prison set outside the perimeter of everyday life where society’s pariahs are contained. Ruby (Emayatzy Corinealdi, whose beauty rivals Lena Horne and Halle Berry) has come, as have other devoted women, to visit her man who is serving time. Ruby radiates hope for her recently married husband Derek (Omari Hardwick, who fills the screen with the body of a NFL fullback, the face of a poet, which he happens to be outside the theatre, and a voice reminiscent of Denzel Washington); it is early on in his nine year sentence, and she bursts with love, resilience – and self-deception. She is a registered nurse who had begun medical school. Forget about becoming a doctor if you need to earn money to pay for your husband’s legal fees and child support from a previous marriage as well as dedicate yourself to the cause of his early release; plus, it is hard to get the on-call schedule to conform to regular visits to the prison, two hours away, each way, and to be free for daily phone calls from her inmate husband.

The United States has the highest rates of incarceration in the world: Recent data indicate that about one in about 30 men and women over 18 (7.3 million people) were imprisoned or on probation or parole.  Nine percent (9 %) of blacks aged 25-29 in their late twenties are in prison compared to 4% of Latinos and 1.4% of whites (http://www.prisonpolicy.org/). Black men have the longest sentences, which add to their high rates behind bars. Their plight is furthered as 35% of blacks are living in poverty (http://www.statehealthfacts.org/comparebar.jsp?ind=14&cat=1), unlike whites at 13%. Children are not spared, creating generations of poverty and fostering crime, as 38% of blacks under 18 are living in poverty, while the national average is 22%, leaving this still prosperous country with little to be proud of (The National Poverty Center http://www.npc.umich.edu/poverty/).

Ruby is from a family of women. Her father is absent.  Her mother, Ruth (Lorraine Toussaint), is living arduously on her own, painfully distanced by her two daughters. Ruby’s sister, Rosie (Edwina Findley), is a tough minded, single mother of a young boy, whose father is also nowhere to be found and whose only uncle is locked up. These three women are seemingly going nowhere with meager financial and emotional provisions and a boy who will absorb their pain, putting him at risk for an uncertain future. Welcome to too much of black America.

But Ruby has something special. She is smart – smart enough to get into medical school – and has not been bled of the hope that is critical to finding an exit from the virtual prison of poverty, dissipated families, violence, incarceration and ill health that blighted urban neighborhoods spawn, and produce the lost lives and social burden that so deeply ail this country.

Prison changes people, and usually not for the good. Prison changes those within its walls, and their families. Derek, a non-violent felon, learns to survive inside by becoming a prison gang member, and maintaining criminal contacts outside for the money this will provide his family. Prisoners’ wives are called “women in waiting” who try to raise children with no money and no man. Their rates of physical and mental illnesses are high (http://www.jjay.cuny.edu/centersInstitutes/pri/events/120805Families/Riding%20the%20Bus%20Johnna%20Christian.pdf).

Ruby has her profession and occasions upon a man, Brian (David Oyelowo, whose credits include award winning performances in the Royal Shakespeare Company), who makes her feel beautiful and not alone. The arc of her life begins to change as spousal betrayal and everyday opportunity collide and begin to lift her from her slavish rut. But her devotion runs deep to those whose life is compromised, as it is in her family and community. She becomes even more in the middle of nowhere.

Director, writer and producer, Ava Duvernay (winner for Best Director at Sundance this year), is the grand painter and author of this cinematic tableau. It is the kind of fiction that Philip Roth said, to paraphrase, is not so, but so very true. After doing documentary work, Duvernay retrieved and developed this script which had sat idle for years. The narrative we observe on the screen thus combines the eye of a field worker with her gift for literary composition.

I wonder: were the cast too beautiful? But who wouldn’t want to look at Emayatzy Corinealdi all day, or her hulk of a husband or the man who later declares that he wants to be part of her future. Or her sister, Rosie, who still has the luster of youth. Even their mother seemed to me more like a high school principal than a poor black woman. Maybe their attractiveness makes them more accessible to an audience like me?

The Middle of Nowhere is yet another remarkable film supported by a Social Action Campaign (http://www.takepart.com/MiddleofNowhere) from Participant Media (Company with a Consciencehttp://www.huffingtonpost.com/lloyd-i-sederer-md/company-with-a-conscience_b_854598.html). Participant’s films include The Kite Runner, Charlie Wilson’s War, An Inconvenient Truth, Good Night, and Good Luck, The Visitor, The Soloist, Waiting for “Superman,” Fair Game, PAGE ONE: Inside The New York Times, The Help, Contagion, The Best Exotic Marigold Hotel,  and the forthcoming Lincoln. Their campaign for this film aims to address prison phone rates (that can exceed $200 a month) that prey on the families and friends of those who are incarcerated. They have found another just cause, an example of how inequity breeds injustice.

Where do we find Ruby as time goes by and more years stare her in the face before Derek stands a chance of release? In the middle of nowhere. She is not able to leave him emotionally and also not able to sacrifice her life for him. But a serenity, different from what her sister and mother display, embraces her face. We leave her, or she us, at a bus stop. She says, with warmth and resolve, “Good morning.”

Originally published in the Huffington Post/AOL on October 13, 2012

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The Master

“You can’t take this life straight” The Master’s lioness wife (Amy Adams) hurls disdainfully at a drunken Freddie Quell (Joaquin Phoenix) when he unceremoniously returns to see the Master, who has sought haven in England and who beseeched Freddie to return to the fold. This late scene in the movie exposes many of the themes of this Rubik cube of a movie: Who is the master? Who has some measure of freedom from mastery? What is the magnetism that bonds the Master, Lancaster Dodd (Phillip Seymour Hoffman), to his dissolute patient, bulldog and intermittent follower? What propels a movement – one based in mysticism and built with hucksterism? And can anyone bear life straight, without some form of ‘opiate’?

Writer and director Paul Thomas Anderson acknowledges that The Master was modeled after the late L. Ron Hubbard, founder of Scientology. But this is not a film about Scientology or about Hubbard, any more than another of Anderson’s films, There Will Be Blood, was about the oil tycoon who inspired its genesis. This is a film about the extraordinary complexities of human character and relationships. It could serve as a textbook for a lengthy psychology seminar.

The story begins in the waning days of World War II, when Freddie was a sailor on a highly decorated battleship. The war did not do his persona much good, but we realize he already was a damaged soul. After the war, we see him wander aimlessly, recklessly and self-destructively from job to job, making and taking poisonous drinks, until fate has him pass by the beacon emitted by Lancaster Dodd as he entertains a group of mesmerized followers reveling on a rich donor’s cruise boat. Freddie stows aboard and a catalytic engagement ensues between the two men, far beyond their getting high on Freddie’s brand of moonshine. Freddie, with nothing to lose and already far at sea in many ways, is eager for some work, room and board, so he is game for Dodd; but what in this current world (since past lives are already up for consideration) does Dodd see in and want from Freddie?

It has been said that a deeper look at any healer will disclose how much he (or she) seeks to be healed. Dodd is a healer who needs healing. And, as well, he is selling his wares as a visionary who can “cure cancer” and deliver “world peace” in a world recently beset with nuclear warheads so he needs some proof that his brand of magic works: Freddie is to be his “protégé and guinea pig”. But I think it is the love between the two men, homoerotic but not in a bodily way, that fuels their relationship and has each remain a devotee of the other despite abundant opposition from family and supporters; it is this love that enables them to withstand the withering disappointments they each serve up to one another.

Lancaster Dodd, The Master, is a fine example of what Hervey Cleckley’s timeless study, The Mask of Sanity (1951), said of the psychopath:  Is it not he himself who is most deeply deceived by his apparent normality? Cleckley was saying that the psychopath first and foremost deceives himself. Dodd was no Hannibal Lecter, another connoisseur and physician yet a bizarre nightmare of a man, but Dodd was a psychopath. His son says “he is making it up as his goes along” and publishers and ardent followers are soon awakened to their deception, their grief and outrage as great as was their faith in The Master.

An oceanic, spiritual, metaphor is strong throughout the film: we repeatedly see images of the sea and the wake of a ship churning the deep blue; Dodd’s movement asserts a billion years of life connected over time and through a force different from God but no less powerful; and our ceaseless yearning to fill a spiritual and human void is what gives his movement (and so many others) its raison d’être, the purpose it can serve – and exploit.

The penultimate scene has Dodd’s wife excoriate Freddie and then leave the two men alone in a manor house salon of considerable grandeur. Dodd, still prosperous and dapper, wants to rekindle their broken attachment and help Freddie, physically wasted and emotionally empty, recover a life before he comes to his end on this earth. Here is where we witness the dénouement between who is master and who is free of any master. Here is where we listen to Dodd croon, lovingly to Freddie, the tune Slow Boat to China:  “I’d love to get you…On a slow boat to China…All to myself alone.”

This is not a feel good movie. But it is a master class in acting. It is a haunting fictional story that is all too true. As with great writing, it takes us into the labyrinth of human nature, rife with emotional hunger, desperation and rage. When that happens it is not only the characters on the page or screen who agonize. We too also gnaw with the pain that is uniquely human.

Originally published in the Huffington Post/AOL on September 22, 2012

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‘Take This Waltz’ (or let it pass?): A Movie Review

Margot, a 28 year old married copy writer in Toronto stunningly portrayed by Michelle Williams (My Week with Marilyn, Blue Valentine, Shutter Island), describes when babysitting for her niece and the infant cried that “nine of ten times” she was hungry or tired or had a rash, or something – but there were those times when nothing could be found. Margot imagined this to be a passing ‘melancholia.’ The infant was inconsolable. Yet the distress was transient, it would pass; though when it manifest there was nothing Margot or anyone could do. Suffering comes from within, even at such a tender age, and it is as inescapable as it is hard to bear.

Margot is married to Lou (a non-comedic though warm and funny Seth Rogan) and they live a twenty something striving life in a cool home on the perimeter of this city that is more than Canadian in its aspirations, as are the protagonists in Sarah Polley’s painfully incisive look at the human condition. Margot’s encapsulated pain is punctured when she meets Daniel (played by Luke Kirby – and what an acting feat he achieves in holding up to Michelle Williams) while covering an assignment in Nova Scotia. The magnetism between them begins to build slowly like a waltz that cannot but conclude with a crescendo. His allure is inescapable since it turns out he lives right across the street – in other words, in the same geographic (and psychological) neighborhood she inhabits. In the disarming way that everyday lives unfold Polley’s film presents our collective dilemma: Are we all alone? Is this what generates the melancholia? Is there anything we can do about it?

Scene after scene inspects each character, especially Margot who appears as a fresh and lovely youth whose ingénue is strikingly contrasted by her angst. The film’s pace, over nearly two hours, is slow which only adds to the ache it elicits. The languor is one way the director hypnotically brings us into the  film’s story (which she also wrote), lingering on an abundance of nuance, confusion and minute variations of facial expressions that reveal the characters’  core, and mirror our own. Sarah Silverman plays Lou’s alcoholic sister Geraldine, sober when we first meet her but then given the fine acting opportunity later on – in vino veritas – when she declares in a moment of brutal honesty that Margot’s behavior has exceeded her own ignominy as a drunken mother.

The filmmaker’s images that assert that time is not our friend appear throughout the film. One that hits like a hammer takes place in a women’s locker room shower where Margot and Geraldine are seen naked as the summer day is long as are the bodies of half a dozen older women. This scene, too, is stretched with time, like the aging flesh of the older women. Their chorus of voices, rich with experience and misfortune, delivers cautionary advice that no youth can follow since their siren comes from the restlessness within. There may be wisdom that comes with time but it is not accessible to youth until (or maybe not ever) they have already strewn destruction and gouged their souls with losses. There is no counsel that can protect the young from that inconsolable feeling, that one time in ten that comes from within and demands response, even if it may usher in ruin.

We witness the deeply troubling repetition of Margot’s dilemma: she can change her circumstances, her men, but she cannot change herself. She pursues union with another man, and another would be life, but surcease from her pain is not hers to have. Remarkably, the film does not deliver this truth in despair. Instead, like the infant who cannot be consoled, we understand that we all need to bear our pain, find ways to endure, wait until it passes, and enjoy the dance while we can.

Originally published in the Huffington Post on July 2, 2012.

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Lloyd I. Sederer, MD

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Moonrise Kingdom: A tale about purity

Somewhere there exists a kingdom (or queendom) recognizable by its citizens’ purity of spirit and intention. When we happen upon it, should that be our good fortune, we will smile. We will find purity of love, purity of purpose, and clarity of action. Dwellers in the kingdom will need to face adversity for how else can we know that the purity is genuine and not facile, and that what appears authentic has roots deep enough to withstand strong winds and tidal floods? At the end, when all else may be rent asunder, shining through will be something ethereal, something wonderful. It is purity.

Wes Anderson has given us a movie, Moonrise Kingdom, which is more than whimsy and charm (though it has plenty of those).  You know him from works like The Royal Tanenbaums and The Fantastic Mr. Fox. His latest is a wonderfully original film that is worth paying attention to in our age of self-absorption and gnawing cynicism.  And, it is evidence that we can envision, at least through Anderson’s cinematic eye, a kingdom of purity. Set on a craggy island off the northeast Atlantic Coast (the film was shot off Rhode Island but could have been one of the many Yankee coastal states) we are warned at the start by one of the island’s even more peculiar inhabitants that a storm of historic proportions and destruction is coming.

Circumstances like that call for Bruce Willis, and he is there as the island’s police chief, and only cop; while he wears a gun you wonder what it is doing on his holster. His sidekick in maintaining order is Ed Norton as a cigarette smoking, brandy drinking scout master of the Khaki Scouts – with a propensity to lose them. He reports to the indomitable Harvey Keitel, on a nearby island, who is master scout of all, proof positive that incompetence is apt to be rewarded with rank and privilege.  To assure that we understand the gravity of matters, we have Bill Murray (increasingly wild in appearance as he seasons) who is a rich lawyer with four children, living on the island with Frances McDormand (his wife and fellow counselor) in a New England, shingled, center entrance Victorian that earmarks their repressed Yankee character and sizable wealth. They are summer dwellers placed at an opposite pole on the island to the scouts at Camp Ivanhoe.

But the movie belongs to two young actors, Jared Gilman and Kara Hayward, who play Sam and Suzy. They are early adolescent misfits, one an orphan in foster care and the other the child of a dysfunctional family. They both stand accused in the court of human judgments of being odd, of being disturbed, of needing to be controlled.  How little we know about who carries the flame of humanity, kindness and capability, as we come to see. These youth find each other: like electric charges that need to combine they fall in love. They run away. They get others to run away. They change minds and hearts, not by trying – mind you – but by pursuing their love and independence, their freedom from hypocrisy and our silly rules and conventions. They are the pioneers, literally and figuratively, in this movie about a better world.

I loved the way the story disrobes the goofiness of bureaucracy as “Social Service” (played to a tee by Tilda Swinton) as a nameless functionary whose rigidity can ultimately be bent by legal threats not simply by the prospect of a solution to ‘her’ problem of what to do with a troublesome youth. I smarted at the all too real way that we see how marriages go cold while people seek warmth. The bloodthirstiness of (male) youth was not spared but was trumped by their deeper needs for attachment and justice. Police and lawyers are also at the end of the ironic arrows of the writers’ and directors’ quivers. “Was he a good dog?” the dialogue poses, and Sam tells us “Who’s to know?” We are all made witnesses to the foolishness of casting judgment.

The storm of “historic proportions” arrives on the island. It is Armageddon, for life, limb and spirit.  All are called to respond. It is the moment for the noblest and the purist to step forward, and they do. Even those who do not are brought along by the natural and spiritual forces that impact this iconic island and its motley but all so true to life characters. The story is not exactly redemptive; it is more ethereal than that. It is a story, magically rendered by cast, crew and director, that leaves us feeling that purity is a state that can be achieved, but we may have to let the children lead the way.

This review first appeared in the Huffington Post/AOL on June 18, 2012

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OC 87: The Obsessive Compulsive, Major Depression, Bipolar, Asperger’s Movie

Bradford (Buddy) Clayman is a 47 year old, white, upper middle class Jewish only child from Philadelphia.  While awkward and teased as an adolescent it was not until the end of high school and during his time as a film and TV student at Temple University that he developed major mental illness. He reports that he has all the conditions listed in the movie’s subtitle, and I suppose he did. OC87 refers to the year 1987 when his obsessional disorder drove him into full retreat from a life with people.

The movie depicts how loving (even if divorced) parents, unceasing support, safe and reliable housing, good, continuous treatment with dedicated therapists, and medications enable a person, like Buddy, with emotionally crushing, complex and potentially disabling (forever) mental disorders to enter a path of recovery – even after over 20 years of serious illness. He defines recovery as life with and despite illness. This is what recovery has come to mean in the mental health community – though many are familiar with its roots in the world of addictions. It’s heartening to observe what can be achieved, as Buddy did – and as he so honestly, modestly and touchingly portrays in this documentary about himself.

Reviews in the Huffington Post, the New York Times, the NY Daily News, even NPR, praised Mr. Clayman’s film for its unsparing look at what goes on in the mind of a person flooded with obsessions and fears while also sustaining hope that a life can be rebuilt. My hat, as well, is off to him for allowing us to be witnesses on the road of his recovery. So many people with serious mental illness, and their families, need to see success and appreciate that persistence and hard work can make a difference.

Buddy spent almost 8 eight years as a young man in his 20s in a residential treatment program in Pennsylvania. In the film, we see how lovely the setting is and how caretaking is its clinical director, who remarked she admitted him when he first arrived. We join what seem like current therapy sessions with his psychologist, who even gets out of his office to help his patient confront and master the real world. We go on outings with him and his friends; a funny one was to a speed dating bar in Philadelphia. We meet Buddy’s dad who gave him work and unwavering emotional support; we spend time with Buddy and his mom, whose love and humor are wonderful to behold. His parents financed this movie.

But what about those not as privileged as Bud Clayman? Those without loving parents and financial resources? Those who worry day to day about where they will sleep, or can sleep safely? Where their meals will come from? Who have little understanding about treatment or how to access it, no less with expert therapists, even residential programs? What about those people? They are legion, in far greater numbers than those fortunate by birth and circumstance to have had the advantages that Bud Clayman did.

Buddy has been the recipient of what all people with a serious and persistent mental illness require: careful, continuous clinical care; supportive family and friends; stable and safe housing; opportunities for school and work; and sustained hope in his capacity to build a life of contribution in his community. The challenge for our society is how these essential ingredients can be delivered to all who need it, regardless of social and economic standing.

Unfortunately, in this country (and many others) we are far from meeting and succeeding on that challenge. Fewer than one in five people in the USA are properly diagnosed and effectively treated (with accessible services and treatments proven effective and delivered in respectful and continuous ways). The results are all too evident: overuse of expensive emergency and hospital services; shocking and unnecessary street homelessness; shelters, jails and prisons ‘housing’ people with mental illness; reliance on welfare and disability payments; and disrupted families and communities. The Claymans did not face these problems but ‘there but by the grace of God’ they could have.

Bud Clayman has given us a message of hope. But for those that look beyond him and his family we are left with the inescapable task of making what was possible for him possible for everyone so afflicted. A quality, accessible, accountable public mental health system, fully integrated with health, housing and social services, is the safety net for those who will not by birth have what Buddy did. National and state health and mental health reform underway right now provide a unique time for us to do more of what we know can work. We owe that to the other Buddys of this country.

Originally published in the Huffington Post/AOL on June 4, 2012

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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 19th 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 19th 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 20th 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 10th 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 Piperhttp://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.