Life and Death Reporting – A Book Review

André Picard has been reporting on health and healthcare for The Globe for over thirty years. His book Matters of Life and Death: Public Health Issues in Canada is a collection of oeuvre from that period, focusing on some of the most important heath issues of that period and for Canada today. Apart from being a practicing psychiatrist, I did work for a time in health policy for the Canadian Medical Association and I haven’t quite shaken the habit. Mr. Picard’s book has become a reference for me and I am referring to it time and again when discussing or considering healthcare.

The book is organized into fourteen sections on what are arguably the most important topics in Canadian Healthcare. Picard cites fourteen areas of healthcare that deserve immediate attention because of their impact on Canadians’ health and our health care system. These are Medicare, Mental Health, Drugs, War on Drugs, Aging, End of Life, Children, Reproductive/Women’s Health, Disability/Inclusion, Indigenous Health, Cancer, Infectious Disease, Lifestyles, Social Determinants. Each topic has its own chapter and the book is very readable and understandable even if reading about health and healthcare is not easy for the reader. As someone who promotes health literacy to the sixteen year old adolescents in my practice, this is important. The short articles in each chapter are interesting and well-written. Members of my team and I used Sip on this: Like all drugs, alcohol isn’t Consequence free for a group about alcohol use in teens.

As I said before, this book has become a reference for me on Canadian Healthcare. I like to have good health policy information, to have the correct statistics and an impression of how others might be considering a health policy topic. Matters of Life and Death was accurate from these perspectives in those areas of health care where I have very good knowledge, which was always reassuring. Also, even when I don’t agree with his opinion, I can always see Mr. Picard’s point of view. This is the essence of good science journalism to me: that it stimulates dialogue and further consideration.

I feel that Matters of Life and Death is a book that every Canadian who wants to understand the problems our healthcare system should read, but I also think they would enjoy it. I will also say that the most valuable information provided was found in the Introduction. Mr. Picard compiles a list of the shortcomings of health reporting. He cites a list developed by Gary Schwitzer, a well-known American health journalist, and then develops the list further. That list is a lens against which one can evaluate journalism on healthcare, a good tool to have when you’re trying to decide whether an article is worth consideration.

(Note: I read the 2017 Douglas & McIntyre paperback edition of Matters of Life and Death: Public Health Issues in Canada.)

(My own photo)

Two Books to Help You Contemplate Men’s Relationships

In the past month, I have read 2 books that I believe helped me to contemplate men’s struggles in relationships.

One of these books was a classic novel and the other was a nonfiction book on the impact books have had on an author’s life.

The novel Giovanni’s Room was written by the American author James Baldwin in 1956. It is set in Paris in the 1950’s and documents the story of a young American man’s homosexual relationship at a time when these relationships were still very much unacceptable in moral terms, even illegal in many countries. In France, however, the changes in law during the French Revolution essentially decriminalized homosexuality although there continued to be a moral prohibition until 1942.

David, the narrator in Giovanni’s Room, is torn between his love for a woman and a man. The account he gives of his internal emotional upheaval is a rare glimpse into the elements that confine men to the gender and social roles that are acceptable. That men can also be thus confined is something I have always accepted in principle, but Giovanni’s Room and David help me to understand how these limitations often keep men emotionally oppressed.

Am I Alone Here? by Peter Orner was published in 2016 and documents how Orner’s reading has shaped his various relationships. Orner’s reading serves as a stimulus to his reflections on being a son, a partner and a father. The intimacy of a gifted reader is so evident in Orner’s writing and is, for me, one of the most important elements of this book.

Orner documents his experience of books as diverse as The Golden Apples by Eudora Welty and The Burning Plane, a book of short stories by the Mexican author Juan Rulfo. Rulfo wrote two books and Orner considers both books as he contemplates that many had waited eagerly for another book, but none was written. Rulfo’s writing was considered so important as to have attracted the attention of García Márquez and Susan Sontag (not to mention Orner himself). Susan Sontag wrote this about Rulfo’s low output:

“…the point of a writer’s life is to produce a great book – that is, a book that will last – and this is what Rulfo did.” (p. 80 in Am I Alone Here?)

As I said, I read both books within the same month, one after the other. They made me feel melancholy about the way in which men can be boxed in emotionally, in a way that I have never felt as a woman. I reflected how difficult it must have been for these authors to expose publicly these intimate internal struggles, each in his own way doing what he could to break apart the box. I felt as though my own thinking about the emotional life of men was much affected by these books, but my thinking made me no less melancholy. I regret these boundaries between our emotional lives.

(Note: I read the Vintage International Paperback Edition of Giovanni’s Room, published in 2013 and the 2016 edition of Orner’s Am I Alone Here? Notes on Living To Read and Reading To Live.)

(Image from Google)

Book Review: Summer and Vermont

One of the best parts of travelling is getting to know a new place. Yesterday was an especially cold day for April and I found myself longing for warmth and spring and vacations. I decided to write a review of books that I took on vacation to Vermont last year. So, if it’s still too cold where you are, you can read about June and Vermont, and think of summer.

In June, I travelled to Southern Vermont and, to prepare for the trip, I read two books. One was the story of someone’s journey and the other was the story about finding a place to stay.

The story of the journey was Bill McKibben’s Wandering Home: A Long Walk Across America’s Most Hopeful Landscape: Vermont’s Champlain Valley and New York’s Adirondacks. Published in 2005, McKibben walks west from his home near Middlebury, Vermont. Along the way, McKibben introduces the reader to the conservationists and farmers working to preserve the habitat and the way of life of these two disparate neighbouring regions. This journey was the opposite of my own, since I travelled through the Adirondacks to Vermont. Also, I drove, while McKibben walked through backcountry trails. Some of the trails he took were not even well-documented.
McKibben considers this landscape to be hopeful because there is so much wilderness. This journey is a reminder to the reader, who may presently be despairing about the prospects for the American wilderness, that there are not just people working to preserve it but, in fact, an organized network of people for whom this land and these places are a sacred trust. These lands around Lake Champlain, both in Vermont and New York, are enduring, with a way of life that represents the best of America and we are reminded that it will take many years, many eras, to change that. On the New York side, Adirondack Park, 6 million acres, is the largest publicly protected area on the North American continent. Like most Canadians, I am inclined to be smug about Canada’s conservation record but McKibben’s account and journey are a reminder that America still does everything bigger! (President Teddy Roosevelt set aside 194 million acres of Land for conservation. President Barack Obama protected 550 million acres. To compare, Canada has 33 million acres of land under protection.)

The book about finding a place was An Unlikely Vineyard: The Education of a Farmer and Her Quest for Terroir by Deirdre Heekin. This was written in 2014 and was named the Best Wine Book of 2014 by Eric Asimov in the New York Times. Heekin and her partner own a farm/vineyard in southern Vermont, a region that does not typically beckon prospective winemakers because of its harsh climate. Even though most people would acknowledge this, Heekin reminds the reader at the outset that grapes grow wild in Vermont. This is a touchstone for her along her journey.

Heekin’s book is part memoir, part manual, part history and is so well written that I actually completed it. It seemed like the best textbook on any subject I had ever read. It made me long to spend more time in Vermont getting to know more about the farmers trying to build a sustainable agriculture in this region. But then, this is a book about staying put and so, I returned home, thanks to Heekin, with a renewed interest in sustainable agriculture in my own part of the Ottawa Valley.

As I write about these books, I am reminded of another warmth – the warmth of the American people that I always meet in Vermont. They make me think I could live there. They make me realize that Canadians and Americans are not so different after all.

I was tired of the cold and I needed to think about summer, but in this winter when our leaders are contemplating a new trade deal, with rhetoric advocating protectionism, I want the warmth of our usual relationship with our American neighbours. That relationship has also proven to be sustainable, while “leaders” come and go.

Book review: Exit West by Mohsin Hamid

Mohsin Hamid is originally from Pakistan, but it is clear from the Exit West dust jacket information that he can relate to migrancy:

Born in Lahore, he (Hamid) has spent about half his life there and much of the rest in London, New York and California.”
(Dust jacket of 2017 Riverhead Books hardcover edition of Exit West)

I read Exit West over the course of one day as I travelled to New York City. This story of two people, Nadia and Saeed, forced to travel from their homeland because of civil war contrasted starkly with my own quite luxurious journey. The hardship and deprivation they suffered at times was made bearable by Hamid’s prose. Nadia and Saeed endured their journeys, and so I did also. This is a story that dignifies the lives of migrants seeking a better, peaceful life.

One element of Exit West that was striking is that two of the places Nadia and Saeed travelled to were Western tourist destinations: Mykonos and London. The author allows the reader to glimpse the separation between the tourist and the migrant. Nadia and Saeed contemplate this at one point in Mykonos:

“…they carried their loads like trekkers in the wilderness and walked along the beaches and up the hills and right to the edges of the cliffs, and they decided that Mykonos was indeed a beautiful place, and they could understand why people might come here…” (page 113)

The persistent metaphor of this novels is doors. Twice Hamid has his two travelers entering a door as they leave each point of origin and emerging from darkness into their new location. These first two times, neither Nadia or Saeed knows where they are going and so, as they emerge, there is a period of disorientation. Both in Mykonos and then in London, Nadia and Saeed find a way to manage relatively well. For their third journey, Nadia and Saeed choose not only to leave, but they also choose where they are going: Marin County near San Francisco – to the United States. Because they have been successful in their two previous journeys, both are hopeful about their move to the United States.

But the other concept that Hamid illustrates in Exit West is that relationships can change meaning and purpose. After their three significant moves together, Nadia and Saeed begin to move apart as if leaving had been, after all, the purpose of their relationship:

“All over the world people were slipping away from where they had been, from once fertile plains cracking with dryness, from seaside villages gasping beneath tidal surges, from overcrowded cities and murderous battlefields, and slipping away from other people too, people they had in some cases loved, as Nadia was slipping away from Saeed, and Saeed from Nadia.” (page 213)

Exit West is a gently told story of migrants and their struggles and a reminder of the great courage it takes to leave the places that are, or become, home. The beautiful writing helped me understand a small part of what migrants face, and I will read all their stories differently henceforth.

(Note: All page references are for the 2017 Riverhead Books hardcover edition of Exit West.)

Book Review: The Undoing Project: A Friendship That Changed Our Minds

The story of the friendship between Daniel Kahneman and Amos Tversky is the story of how our minds lead us to make mistakes. The Undoing Project: A friendship That Changed Our Minds by Michael Lewis focuses on the relationship between two extraordinary psychologists. However, in telling the story of that relationship, Lewis educates the reader about behavioural economics, discipline that arose out of the work of Kahneman and Tversky.

Lewis is a prolific American non-fiction writer, probably best know for his book Moneyball: The Art of Winning an Unfair Game. He is a remarkable storyteller – in fact, even after I had read The Undoing Project, I couldn’t quite figure out whether Lewis had meant to write about a friendship or behavioural economics. Even in the introduction to the book, Lewis hints at this dilemma himself:

“What possessed two guys in the Middle East to sit down and figure out what the mind was doing when it tried to judge a baseball player, or an investment, or a presidential candidate? And how on earth does a psychologist win a Nobel Prize in Economics? In the answers to those questions, it emerged, there was another story to tell.” (p.19)

With this beginning, Lewis tells the story of Tversky and Kahneman and their friendship – and the tale is compelling. Most people would find that they cannot stop reading. Two clever men, both Israeli, with very different personalities are intellectually attracted and out of their collaboration they make discoveries about how we think that will ultimately change how we think.

Those of us who practice medicine are certainly aware of Kahneman’s and Tversky’s work. Their work, as extrapolated in to medicine by Dr. Don Redelmeier, working with Tversky. They examined how errors in medical judgment occurred, and particularly in the case of expert physicians who sometimes ignored the data in favour of their own intuition. Most often, in these cases, the doctor will be wrong. This important work has helped physicians to check their thinking, to confirm that they are basing decisions on facts and not impressions.

Because Lewis uses the history of a friendship to help describe important discoveries about how we think, I found that I learned about Tversky’s and Kahneman’s work without having to think about it. I think most readers would have the same experience.

(I read the hardcover W. W. Norton edition of The Undoing Project: A friendship That Changed Our Minds, published in 2017.)

We Should All Be Feminists

As International Women’s Day approaches, I wanted to mention a short book, adopted from a TEDx talk that you could read to reflect on what feminism means in this #MeToo age. Chimamanda Ngozi Adichie is an award-winning novelist from Nigeria and she wrote We Should All Be Feminists.

Adichie argues that “Boys and girls are undeniably different biologically, but socialization exaggerates the differences.” (p. 35) If socialization exaggerates the differences in North America, this experience is even more extreme in Africa and this has clearly shaped Adichie’s narrative.

In fifty brief pages, we can review some of the most important challenges facing the gender equity movement and contemplate how to continue to move forward. Of all her messages, the strongest is that we must continue to raise both men and women differently. I believe that we are all trying to do this, and the evidence is that we are mostly successful.

Feminists, female and male, are not the only people trying to raise our children, however. There are many individuals and organizations around the world, with access to our children via media and social media, who are also influencing our youth. Many of these are seeking to maintain the status quo. Why even our culture, as Adichie points out, gravitates to the status quo all around the world.

In this week leading up to International Women’s Day, find Adichie’s text or TEDx talk. Contemplate the role you have played in improving women’s lives, and then keep going. There’s still a lot of work to do, but I hope this little book will renew your energy as it did mine.

(Note: I read the February 2015 Anchor Books edition of We Should All Be Feminists.)

Seasonal Affective Disorder? Or a Bad Winter?

In Eastern Ontario, this has been a winter for the record books: long periods of deep cold alternating with difficult periods of precipitation and very few days of temperatures that make for a pleasant walk. Just this past week the temperature fell 30 degrees within 12 hours and the precipitation turned from rain, to freezing rain to snow. I find that whenever there is a difficult period of winter weather, more patients will ask, “Do you think I have Seasonal Affective Disorder?” Because of the weather, there are many more people asking that question this year so a brief primer and some references might be helpful for some of you.

Norman Rosenthal is the psychiatrist who, with his research team, first described Seasonal Affective Disorder (SAD) and his book, Winter Blues: Everything You Need To Know To Beat Seasonal Affective Disorder, is still one of the best references on the condition. It is available now in its fourth edition. The book is easy to read and still provides some of the most authoritative information with respect to SAD. He even has a blog and short video about what you need to know about SAD.

Since I see youth and young adults in my practice, I should point out that this group has a higher rate of Seasonal Affective Disorder. It is interesting that, in his blog about SAD in college students, Rosenthal suggests that parents can have a protective effect on youth vulnerable to SAD since they will remind them to get enough sleep and to care for themselves. When one is away from home for the first time, it takes awhile to learn selfcare and so these students might be more vulnerable to a condition that causes decreased energy and a sleep disturbance. This is Rosenthal’s contention so it follows from this that if you, or a family member, suffers from Seasonal Affective Disorder, a good way to support them is by helping them to maintain a reasonable schedule, especially with respect to getting enough sleep.

The symptoms of Seasonal Affective Disorder include:
1. Difficulty waking
2. Decreased energy
3. Difficulty concentrating
4. Increased appetite especially for sweets and starches
5. Weight gain
6. Anxiety
7. Decreased interest in socializing

These symptoms can interfere with a person’s capacity to manage their regular work or academic schedule and if you’re experiencing these, there are some things you can do that may be able to help.

First, look up the material I’ve included and consider whether you might have Seasonal Affective Disorder. Even if you’re not certain, there are some health measures you can take that have no risk and that could be helpful. Start with getting more light: go for a walk, especially a morning walk and find ways to let the sunshine into your home or workspace. You can use a timer or a dawn light at your bedside table to “start” the daylight a bit earlier. You can also get a specific light for Seasonal Affective Disorder. These are available in medical supply stores and some insurance plans even cover the cost.

You can also develop some basic Cognitive Behaviour Therapy techniques. Learn to recognize and manage negative thoughts and find some things to do that always help you to feel better. This last suggestion seems to be very hard for many people for whom depressed mood can be problematic. When there is a depressed young person on the inpatient unit, one of the most enjoyable and rewarding things to do is to help them find activities that always help them to feel better.

Finally, when should you see a doctor if you think you might have SAD? If your functioning at work or in school becomes affected, it’s time to discuss with your family doctor whether more treatment is required. Some cases of Seasonal Affective Disorder can be so severe that antidepressant medication will be needed.

All of this does not address whether a winter such as we’re having in Central Canada results in more cases of Seasonal Affective Disorder. Well, this does not seem to be supported by research. I cannot quite believe it myself. When I get ready to leave for work in the morning and I can’t quite face the 10-minute walk because it’s -30 degrees centigrade and there’s a wind chill factor on top, it would be great to feel justified in worrying about an increased risk of SAD. But it’s not the case. In fact, the short walk in the bright morning is likely just what I need to prevent the condition.