An absorbing insider’s view of upheavals in mental health care that explores the human impact of cold economics.
Sederer recalls his fight to save a foundering mental hospital in this searching memoir.
The author, a former New York City mental health commissioner, recollects his 11-year stint, starting in 1989, as chief medical officer of McLean Hospital, Harvard University’s psychiatric teaching hospital and an institution storied for treating celebrities and poets. The hospital was hemorrhaging money; McLean’s model of monthslong inpatient stays, centered on psychoanalytic talk therapy, was too expensive—and medically ineffective, the author contends—to survive. Sederer introduced a radically different acute-care model based on two-week stays, during which doctors stabilized patients with the help of psychiatric drugs before discharging them for long-term outpatient care. The shift enraged the hospital’s more entrenched attending physicians; they were further miffed, the author asserts, by initiatives to expand the hospital’s services and bring in more patients, all of which meant more work for them. Much of the book is an intricate study of managerial change, with Sederer describing how he built his executive team, cultivated his board, and eased out opponents. He also recaps colorful psychiatric cases, including that of a doctor who eloped with a manic-depressive patient, necessitating a police manhunt. The author offers a biting critique of corporate medicine’s fixation on profits over patients while advocating for a more streamlined, cheaper, more pharmacological, and less Freudian psychiatric paradigm. He also attacks what he considers bad practice: Sederer opposes psychoanalysis for psychotic patients (he says it can destabilize them), calls for simplifying complicated drug regimens, and frowns on restraining and sedating patients. The author’s lucid, plainspoken prose makes medical issues accessible to laypeople while conveying the drama of McLean’s bitter office politics. (One attending physician “sat at his rather empty, big old oak desk, squarely facing me. He said I would fail, that I would be out of McLean in disgrace in short order, too. I said nothing in response. It was a brief meeting.”) Doctors and casual readers alike will find interesting food for thought here.
An absorbing insider’s view of upheavals in mental health care that explores the human impact of cold economics.Pub Date: Jan. 9, 2024
ISBN: 9798886451290
Page Count: 208
Publisher: Greenleaf Book Group Press
Review Posted Online: Jan. 29, 2024
Kirkus Reviews Issue: March 15, 2024
Review Program: Kirkus Indie
BOOK REVIEW
BOOK REVIEW
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
PERSPECTIVES
A philosophically rich critique of state violence and mass apathy.
An Egyptian Canadian journalist writes searchingly of this time of war.
“Rules, conventions, morals, reality itself: all exist so long as their existence is convenient to the preservation of power.” So writes El Akkad, who goes on to state that one of the demands of modern power is that those subject to it must imagine that some group of people somewhere are not fully human. El Akkad’s pointed example is Gaza, the current destruction of which, he writes, is causing millions of people around the world to examine the supposedly rules-governed, democratic West and declare, “I want nothing to do with this.” El Akkad, author of the novel American War (2017), discerns hypocrisy and racism in the West’s defense of Ukraine and what he views as indifference toward the Palestinian people. No stranger to war zones himself—El Akkad was a correspondent in Afghanistan and Iraq—he writes with grim matter-of-factness about murdered children, famine, and the deliberate targeting of civilians. With no love for Zionism lost, he offers an equally harsh critique of Hamas, yet another one of the “entities obsessed with violence as an ethos, brutal in their treatment of minority groups who in their view should not exist, and self-decreed to be the true protectors of an entire religion.” Taking a global view, El Akkad, who lives in the U.S., finds almost every government and society wanting, and not least those, he says, that turn away and pretend not to know, behavior that we’ve seen before and that, in the spirit of his title, will one day be explained away until, in the end, it comes down to “a quiet unheard reckoning in the winter of life between the one who said nothing, did nothing, and their own soul.”
A philosophically rich critique of state violence and mass apathy.Pub Date: Feb. 25, 2025
ISBN: 9780593804148
Page Count: 224
Publisher: Knopf
Review Posted Online: Dec. 14, 2024
Kirkus Reviews Issue: Jan. 15, 2025
BOOK REVIEW
BOOK REVIEW
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