Purge: Rehab Diaries

Purge: Rehab Diaries
by Nicole Johns
2009
274 pages
ISBN: 978-1-58005-274-0
Cincinnati Public Library

I got this book out of the Cincinnati Public Library when I saw it on the "New Books" shelf. That particular library visit was during Brain and Behavior II (which included pretty much all of the psychiatry that we're going to see). I thought that this might be a useful read because while I think that I know a decent amount about most types of psychiatric treatment, I didn't feel like I really knew much of anything about the treatment of eating disorders.

For the purpose of learning more about inpatient eating disorder treatment, this book was certainly useful for me. I think that it was also useful for me in that it is forcing me to face the reality that I actually have somewhat limited sympathy for eating disordered patients. I find them frustrating. I feel this way even though I believe that their disease is a real one. There were points in this book, when Johns sneaks off to purge after a meal, and I literally wanted to reach into the book and slap her upside the head. This is a woman who has serious heart arrhythmia at the age of 22 due to her eating disorder. She really needs to stop vomiting. Really. Now.

Now as someone that is very seriously considering a career in child and adolescent psychiatry, this is obviously an issue that I am going to have to work on, so I have to admit that it is useful to be able to acknowledge it at this point in my life. I'm not sure really what I'm going to do about it, but I guess admitting that you have a problem is the first step, and I admit that I really have a problem here, and that deep down inside, I not-so-secretly want to feed those girls a cheeseburger. I think they'll feel better.

To be fair, I think that part of my struggle is that Johns expresses some of the stereotypes that so often go with eating disorders that I personally think undermine my ability to take them seriously as medical disease. She describes herself as a perfectionist and an overachiever that is looking for control in her life, over and over again. I know that perfectionism is linked to eating disorders and on and on, but I am an upper middle class, over-achieving, perfectionist, white woman from the east coast, notorious for putting unreal expectations on herself. And seriously, I love a good cookie. Too much really. I need to stop with the cookies.

There is a part of me that realizes that because I fit the demographic of this disease but find it so foreign, so unimaginable, that should make the idea that it is genetic/medical/biochemical all the more legit. Because it's not just being a perfectionist. Really. And it's not just always wanting more from yourself. There is something else going on there. But the patients and doctors and general public so often attribute this disease to women taking control of the an area of their life that they can control when they feel that other parts of their life have gotten out of hand. I think that's a VERY bad way to think about it. Because, really, that description includes the words "something they CAN control" with regards to the eating/exercising/purging habits of these women. And I have to believe, if I want to have sympathy for them, if I want to ever be able to develop into someone that hopes to be able to deal these patients in any sort of therapeutic way, that it is not something that they can truly control. I have to believe that they have lost control and that the goal of treatment is to help them find it. Because if starving themselves or throwing up after all their meals IS a choice, then I want to feed them a cheeseburger. With Bacon.

Johns does a good job of capturing that out of control feeling, and she does a decent job painting a picture of eating disorder treatment in a way that I think was useful for me to encounter. This is an adequate memoir for what she says in the prologue she is trying to accomplish, but as one of the recent crop of memoirs from people too young to be seriously writing memoirs, it's really middling.

That's not to say that reading this is not going to affect my thinking, because it has. It challenged me, but that is more because it made me realize something a little bit ugly in myself than because it is an outstanding piece of writing. Still, for what I got, I am grateful. The thought process that pops into my head listening to people describe their eating disordered behavior is different and downright mean when compared to that which is in my head during accounts of other psychiatric disorders. That's something that I am going to have to deal with, something that I am glad I can admit to myself now, while I have a long time to wrestle with it. Because if nothing else was clear in this book, these women need some help.

Coppola: A Periatric Surgeon In Iraq

Coppola: A Pediatric Surgeon in Iraq
by Dr. Chris Coppola
2009
259 pages
ISBN: 978-0-9840531-1-7
ARC from LibraryThing Early Reviewers

For better or for worse, LibraryThing has pegged me as a reader of medical memoirs, and when one comes up in the Early Reviewers list, if I request it, you can bet that I'll get sent a copy. Since I joined a year an a half ago, I've gotten ARCs of Weekends at Bellevue, Brain Surgeon, and The Addict. I'm not complaining about this per say, especially since I would have wanted to read these books anyway, but I wish that they had also pegged me as the compulsive reader of fiction that I am, and sent me The Angel's Game and Last Night in Twisted River when those were on the list. I certainly will read and review every medical memoir they send my way for free, but there are other books that I want to read more and I hate to think that I don't get them because I've been pigeon-holed. Such is life.

That being said, Coppola: A Pediatric Surgeon in Iraq is one of the better medical memoirs I've read. In the book, Dr. Chris Coppola recounts his experiences during his two tours of duty in Iraq as a surgeon with the US Air Force. Coppola manages to achieve the perfect balance in his writing between the action of clinical cases and using his experiences to inform a discussion of the ethical and cultural issues he encountered and the challenges of military life.

Dr. Coppola's unique position as a specialist in pediatric surgery means he has a skill set sorely lacking in the current Iraqi medical system. Throughout both tours, he struggles to find balance between his compassion and sense of obligation to the young patients he encounters and the realities of his position, the position of the US military, and the medical treatment available in Iraqi hospitals outside of the American medical base. There are times when he fights hard for his patients when others disagree with his call, and times when he is forced to turn patients away. He makes a compelling argument for the role of pediatric specialists in war hospitals, especially given the rate of civilian casualties in the IED era. Dr. Coppola is not shy about calling the problems of military medicine to the forefront of our attention, while at the same time making it clear that he has found satisfaction in his service.

Overall, this is a strong memoir that calls to mind some important issues that come with our current presence in Iraq, many of which likely extend to our increasing presence in Afghanistan. It is a timely and important read, and one that I would certainly suggest to other people in the medical field and outside it.

Go Ask Alice

Go Ask Alice
Annoymous

So Andrew gave me this book. He picked it up for some reason, and when he was done he passed it on. Last night I was looking for something easy and distracting while I was cleaning my room (which for me is neither easy nor distracting) and I picked this up off my bookshelf. I know that some people will veiw it as some sort of blasphmey that even as a coompulsive reader in my tween and early teen years I'd never read it... but I hadn't. What are you going to do? Now I have.

Anyway. The point of this book is pretty clear. She's a pretty normal teenage girl who gets into drugs, has a hard time leaving them behind, finds herself in a number of regrettable situations, and ends up dead. Drugs are bad. I think that we can all understand this.

The thing is, I'm not sure that this girl is a particularly great example of the whole "drugs are bad" motif. Her story has a lot of things in it that are not quite typical of your teenage drug addict, and the message would be anything but encouraging for a kid who had tried drugs but was trying to stop.

First of all, she doesn't make a consious choice to take drugs the first time. Instead, she is given a coke laced with LSD at a party and that starts her down the path to destruction. Somehow, I'm not sure that the warning "don't take coke's from kids you only kind of know" is not the same kind of warning as "don't take drugs." And while I suppose that the message might be something along the lines of "just trying drugs can set you off in the wrong direction." And clearly she makes a number of (VERY) bad choices in the period that follows this first experience, that little bit of trickery made me feel bad for her.

Second, her descriptions of the experience of drug use are enough to make even a psychopharmacology nerd a little curious. Even though she clearly states about a million times toward the end of her diary that the experience isn't worth it, I'm not sure the descriptions of complete and utter bliss and drug induced euphoria would be particularly helpful in the hands of especially curious preteens. I suppose here the message that trying it once can mess you up is justified... since she makes being high sound pretty damn great. Too bad that one LSD trip leads inexorably to scratching your own face off and premature death.

Finally, at the end of the diary she seems to be well on the path to recovery. She's made new friends that aren't into drugs. She's got herself a responsible college boyfriend who is not into drugs and who has a relationship with her parents as well as with her. All of the last journal entries are those of a hopeful young woman who has left a dangerous and destructive past behind her.

And then in the epilogue, she's dead.

What happened? I mean really. I don't think that this is the message that you want to give to young people. "You'll be on the right track, you'll make new friends and make every effort to start a new life, but really there's no hope. Just when it seems that you are on the path to a full recovery and a useful life, your parents will find you dead when they get home from the movies!"

This is not helpful. Especially not helpful for any child that had tried drugs, as in "Well, now that I've tried drugs, I might as well not waste the effort to get off them, I'm screwed anyway, so I might as well enjoy myself!"

But I suppose the anti-drug message lives on. The way things turn out for her while she's on drugs is clearly not the life that people would wish for, her later resistance of some extraordinarily intense peer pressure is admirable, and her description of her "bad trip" and it's aftereffects are enough to scare the living daylights out of some of those previously discribed especially curious preteens. I suppose.

I think that the real problem with this book is that it seems too forced. Too constructed.

Young girl starts diary about how hard it is not to be accepted, and 20 pages in, she's a drug addict rolling her way straight towards death. Repeated use triggered by neatly spaced traumatic life events. Tries to clean up, fails, faces increadible peer pressure and has a bad trip, but parents always love her. Nice boy that she meets accepts her and even *kisses* her! Doesn't care that she's a former addict, or when she goes crazy, or when she's institutionalized. People that don't use drugs are good and loving. Drugs are bad.


It reads like not terribly well created propoganda. (Which according to the reviews on Amazon it just might be.) I even looked back at some of my journalling from around the same age that this girl is supposed to be. They read more like the journals of a 10 year old than a 16 year old. (And no, I am not just hyper-mature, I assure you.) To me that reeks of adult that has no recollection of what it was like to be 15 or 16. Maybe.

I suppose if I had read it in middle school it would be different. The reviews on Amazon are clearly clustered into jeers from jaded adults and raves from teen readers to whom it seemed honest and dramatic and real. Perhaps if I had read this in maddle school this would be one of those essays about returning to a childhood favorite and finding it lacking.


But I don't think that I would give this to my 13 year old to read, because it is a single minded message about destruction with the utter absence of hope, and if you believe, as I do, that addiction is an illness, than what we need is stories imbued with some element of hope.



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Four other notes about reading, books and Barnes and Noble:



1.) On a re-reading childhood favorites note: Madeline L'Engle died this past weekend. I certainly hope that I don't have to write the "returning to a childhood favorite and finding it lacking" essay about any of those books, since I am certainly going to have to return to them once I finish my little ten book run... or maybe during the ten book run. Kids books make a great little distraction sometimes, and the library will have those. I do own them all, even if they are up in an attic somewhere, so I have no reason to visit Barnes and Noble for this rereading project.

2.) This book doesn't count towards the 10 that I have to read before I return to my wanton bookbuying ways. a.) Because it's not on the list that I made when I made the resolution and b.) because I read it so fast and it was so little that counting it would feel like cheating.

3.) Barnes and Nobel sent me an e-mail on Friday in which they explained that they are going to send me a book for *free.* Apparently, they have this book club thing, and because I signed up for one in the past they have me pegged as a reader type. They are clearly trying to create some buzz around a new author by sending out a bunch of advance reading copies of her book and getting us to talk about them. While this does mean that there is a new book on its way to me in the mail... it does not count as a trip to Barnes and Noble because I neither visited the store or gave them money in exchange for it.

and 4.) We stopped at a Barnes and Noble for coffee last week (since it was the nearest coffee selling place to where we were), and I didn't buy ANYTHING. (Well, execpt coffee, but that doesn't count.) GO ME!

Naked

Naked
by David Sedaris
c. 1997
Little, Brown and Company: New York
291 pages

So as stated in the last entry (for Sedaris' Me Talk Pretty One Day) this book came from paperbackswap.com. My life has been kind of crazy this last week, and this seemed the right kind of book for the sort of disjointed reality, so I picked it up immediately after the last one.

I enjoyed this book as much as the other, but in a very different way. I felt that Sedaris did less well in this book of leaving his extraordinary characters with their humanity (here the absurdity level reminded me more of Running With Scissors on occasion, the jade carving Jesus freak and the penis collecting union man come to mind) but perhaps a better job creating the mood and the reality of the situations that he faced.

I am a planner, a worker, a student, a person with goals and a vision for the next step. Sedaris was a hitchhiker, a dropout, a migrant worker living out of a trailer. It is not a life that I can relate to, and really, I know, not a life that I want, although sometimes I wish that I could convince myself to just pack it up and go. (Maybe this is what I am doing with the upcoming trip to Europe, but it seems that spending two years saving money and planning it out will take some of the mystery out of the whole thing, and obviously there is no hitchhiking or migrant apple picking in my future.) I did find myself intrigued by his wanderings, and by the stories, both good and bad that came from them, and that's what sucked me in. This book had a decent amount of continuity, at least the essays were presented chronologically, and that pulled me in a little more than Me Talk Pretty One Day, because there was some sense of "what happens next?" that I felt less in the other book.

And it did make me think more about the way that I lead my life, as a planner, unlike Sedaris, as someone who is mostly the same around everyone, unlike one of his coworkers, as someone who would probably not really enjoy a week at a nudist colony, but who might need it anyway (like Sedaris I suppose).

So all in all, a good book, although another that I will be passing on without a sense of attachment. This is the kind of book that I for one can mostly read and be done with, I would suggest that if you want it, swap for it, so that if it makes a different impression on you (I can see where it might, depending on where you are coming from) you can keep it, and if not, you can send it along until it finds someone who will want to keep it.

Another ringing endorsement for the wonder that is paperbackswap.com.

Me Talk Pretty One Day

Me Talk Pretty One Day
by David Sedaris
c. 2000
Little Brown and Company: Boston
272 pages

This is one of those books that I saw so many times on tables and display shelves in bookstores everywhere that I went that curiosity got the better of me, and when I saw it at the bookstore a couple of weeks ago, I made a note and searched for it on paperbackswap.com, and had it sent to me be someone in California or Texas or something. (I take a moment here to say that if you are not a member of paperbackswap.com, you should go and join now, its a wonderful thing that gets you free books and allows you to share books that you don't need anymore with people who are going to read them.)

Anyway, the book got to me on Monday, and Tuesday was the day that I had set aside for a full night desperate, this time I really will do this, cleaning of my bedroom (usually an unimaginable disaster area.) I am not a good cleaner, and so I give myself incentives to keep working, and in this case, reading was this incentive. This was a good book for that purpose, because it is a collection of autobiographical essays that are not necessarily connected to one another. That means that each has a definitive end (good for the, "one essay and then back to cleaning" mentality.) Also, because they're disjointed in some ways, there was no feeling of being interrupted by short spurts of reading, something that bothers me sometimes when I just want to know what happens.

I didn't realize when I got this book that it was a memoir of sorts. I suppose that I am on something of a memoir kick right now. The reviews on the back and in the inside cover of this book seemed to suggest that I would be rolling on the floor in sidesplitting laughter and happy to be alone in the house for the night. It wasn't quite that entertaining, but there is very little that I read that pulls that kind of laugh out loud reaction from me (only Douglas Adams and Dave Barry come to mind.) The essays were amusing, some a little absurd, but all around entertaining. It seems that Sedaris has led the kind of life in which he is surrounded by people of extremes (although not as extreme as those that are hanging out with young Augusten Burroughs) and he is able to see and communicate the humor in these situations while still leaving these people with their humanity, something that I think Burroughs occasionally failed to do.

I enjoyed this book for the purpose that it served, but I will be paperback swapping my copy away this evening, as it didn't make any kid of enormous impression on me. However, I had already ordered another of Sedaris' books with this one, and so you get that next (or before this, since I am posting both tonight) because it seemed more like the right kind of book to be reading when I am in kind of a start and stop sort of place, so I can say that I enjoyed it enough to want to read more right away, not too great an endorsement from someone who always wants to [read. more. now.] but an endorsement nonetheless.

Running With Scissors

Running With Scissors

by Augusten Burroughs

c. 2002

Picador: New York

304 pages

One afternoon, when the three of us from work took a side trip to Barnes & Noble, Krystal picked up this book from one of those little display tables (which will eventually be the death of both me and my savings) and told me that I would really like it, but that it was very bizarre.

And it was, and I did like it, but in a strange way. Reading this I got the same feeling that I sometimes get reading Chuck Palahniuk books: that feeling like you are doing something vaguely wrong and voyeuristic. Like you're rubbernecking at a really bad accident on the highway or something. Palahniuk frequently creates characters that are so messed up that just reading about their thoughts and actions makes you think "If those people sitting at the next table knew exactly what I was reading at this moment, they might be weirded out." At least I know I felt that way reading Haunted at Summer Institute last year.

This book has characters that behave in that same extreme socially unacceptable, shocking, horrifyingly strange kind of way. Only according to Burroughs, this is a memoir. He's not making this stuff up. Which only makes it feel more strange and vaguely dirty.

But kind of in a good way. Or at least in a way that made it so I literally could not put this book down (as in, I read one chapter at a particularly long traffic light.)

And so, like Krystal,I recommend it, with the "You'll like it, but it's rather messed up," kind of recommendation. If you think that you can handle (and this is the incident that Krystal described to me before I read the book) the family hovering over the toilet because they believe that God has chosen to speak to them through the shape and consistency of thier shit, (and I'm not even kidding) then this is the book for you.

Although I warn you, it's not for the faint of heart, or the easily angered, for there were certainly moments in which I wanted to slap several major characters upside the head and then lock them up for the remainder of their natural days. The psychiatrist that suggests that his thirteen year old patient could get himself out of school by staging a suicide attempt, and then provides him with the Valium and Jack Daniels to do just that comes to mind.

So yeah, it might be a little too bizarre for some people, and a lot too bizarre for others. But it is still a very good book. Even in the moments were I was repulsed, I was intrigued, and certainly involved. I suppose that anything that creates the kind of visceral reaction that I had to this book deserves a good amount of credit. Even when appalled, I had no intention of putting it down. And I now have every intention of reading Burroughs second memoir Dry once I get my hands on it.

So yeah, if you really like Palahniuk, I suspect that you will also enjoy this real life version, but if you read Invisible Monsters or Lullaby and were shocked by the strangeness of his fictional characters, I suspect that they reality of this book will be more than a little bit too much for you.