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.)

Game of Thrones Madness?

For the past few weeks, I have felt as though my husband and sons, not to mention many friends and acquaintances, have joined a cult. As a matter of fact, I often spend Sunday evening with my family, but tonight and for weeks to come everyone I know will spend Sunday evenings with characters from a fictional land.

Here are some of the comments I have heard in the past few weeks leading up to the 7th season of Game of Thrones which starts tonight on HBO:

Question: “What if we tape the whole series and binge watch them all at once for a kind of party?”

Answer: “You can’t do that because you’ll definitely have the plot spoiled by everyone talking about what has happened.”

Question: “If I go away for a week, do you think I should stop following the Twitter feeds and other social medial?”

Answer: “OMG I never thought of that.”

Question: “Do you think we can find out in advance who’s going to be live tweeting during the show and stop following them?”

Answer: “Good idea – and put up warnings for your followers not to post.”

Question: “Dr. Beck, will we be allowed to watch Game of Thrones on the unit?”

Answer: “Is there no escape?”

I know exactly why the series does not appeal to me. I find too much graphic violence disturbing. It’s perverse, but I am more fascinated by trying to understand why certain television series can develop cult-like followings. How does it happen that certain shows can become so popular that there’s no point in even inviting anyone over on a certain day around a certain time unless you’re holding an event related to a certain series. My gourmet dinner club held a Downton Abbey event. I know of people holding Game of Thrones parties as the new season starts.

The research on why certain cultural phenomena become popular indicates that the capacity to identify sympathetically with characters, especially when the story line allows us to struggle with concepts of good and evil, can be cathartic. It can help us to resolve our own conflicts safely, especially if, in discussing a show’s dilemmas with others, we can begin to understand how our friends or family members are themselves resolving conflicts.

The cultural phenomena that are television shows or movies have never been as cathartic for me as those I read and, of course, there is research on that as well. This research considers the reasons why some people are drawn to stories told via one medium over another. Again, this research shows that we are drawn to the medium that most engages our emotions, that allows us to enter the conflict of the story safely, so that we are not overwhelmed. I don’t mind imagining a bloody conflict, but I find it overwhelming to watch. I will also admit that I skip over parts of tv shows or movies that I find too difficult to tolerate, but I never have to do this when I’m reading a story.

Finally, whether you watch or read or listen to a story, stories show us how difficult it is for humans to live in the present, to “enjoy the moment”. We flip to the back of the book. We watch every episode. Do we not all want to know the end of the story, even when the story is good all the way along?

Book Review: Stir

Stir: My Broken Brain and The Meals That Brought Me Home is a cross between a memoir and a cookbook. The theme, however, is not one that many can relate to, although the book will help the reader understand what it’s like to live recovering from a brain injury. At age 28, Jessica Fechtor was on a treadmill when an aneurysm in her brain burst. This is her account of how her favourite recipes helped her to recover.

As a physician, I was particularly struck by Ms. Fechtor’s accounts of her encounters with the health care system. These were certainly a stark reminder that, even in the United States, care is not always what it could be. Consider this description of an occupational therapy assessment:

‘ “How did you bathe before you got sick?” The healthy, unterrified version of myself would have realized that all of this “before you got sick” business was just standard language. The therapist had probably been taught to ask the same things in exactly the same way of each of her patients, many of whom – unlike me – had limited mobility before whatever had landed them in the hospital, orhad suffered debilitating physical or cognitive deficits. But hadn’t she read my file? And if she had, and she still thought these questions applied, was I worse off than I knew? Panic crept along the back of my neck.

‘ “I got into the shower. I washed my hair.” My throat was so tight that it hurt to talk. Why was I speaking in the past tense?

‘ “Can you show me how?” she asked. I lifted both my hands and wiggled my fingers around. She scribbled another something down. Silent tears had begun to squeeze out from the corners of my eyes. I wiped at them with the back of my hand.’ (Page 143)

As well as this interaction, the account of a hospitalization when Ms. Fechtor develops a fever after surgery would leave anyone with concerns about health care. In other words, this is not a book for the fainthearted. Having said this, the book also describes how the health care system comes back after a worrisome encounter and goes on to deliver topnotch care. It is this kind of honesty that characterizes the best memoirs.

Leaving the health memoir to consider the recipes, their integration into the text is extremely powerful. As one reads why certain recipes are chosen, the reader realizes in no uncertain terms that food facilitates health and healing. Ms. Fechtor traces the origins of some recipes to her childhood, others to her travels, but all of the recipes are linked to her own life. It is because of this connection that the food becomes an elixir for her.

Think about this for a moment. Think of the foods that you want when you’re not well. Food, preparing food, sharing a meal are linked to healing and comfort in all cultures. Fechtor’s memoir reminds us of this, and tells us in particular how the recipes she cooked, and that others cooked for her, helped her to recover. Food is not just about nourishing the body; it is about nourishing the spirit and this nourishment is linked inextricably to recovery.

An example to illustrate this idea could be chicken soup. Many people have a chicken soup recipe in their family that is felt to be almost a magic remedy. This book does have a recipe for chicken soup – and its history in Ms. Fechtor’s family. She also provides the secret to producing a clear broth, but I’ll let you discover that for yourself. If you’d like to get a feeling for Ms. Fechtor’s writing, you can find it on her blog. You can also find some of the recipes there. Why not find one and think about the food you like when you’re not feeling well? I made the pumpkin bread.

(Note: I read the first hardcover edition of the book published in 2015 by Penguin.)


Book Review: A Memoir About MS

How would you cope if you or a loved one were suddenly struck with a condition that would affect the rest of your life? That would probably not get better and that would likely get worse? That is what happened to Richard Cohen at the age of 25 when he learned that he had Multiple Sclerosis. His memoir Blindsided: Lifting a Life Above Illness, A Reluctant Memoir tells us how he lived with this progressive disease for 30 years of his life. The span of his life that it covers is one of the ways in which this book is remarkable. You will really learn what it is like to live with Multiple Sclerosis.

Another important aspect of his account is that Cohen is not always “good” at dealing with his condition and the title of the book tells us how he felt when he learned about his condition. He also situates the reader into the paradigm of a privileged man of his generation:

“The trouble with men is that we cannot forget that once we were boys. And boys see their lives   as cinemas until we are forced to grow up, to walk away from the theatres in our heads and go home to reality.” (pp. 30-31)

As Cohen discusses the period in which he first accepted his illness, what he stated crystallized for me what a patient’s role is in the treatment of their illness:

“Attitude is not to be easily dismissed as a source of power and influence governing the course of a disease.” (p.141)

This one sentence says a great deal about what a patient must strive for when they learn they have a chronic illness. That attitude is likely best fostered by empowerment – hence the success of Cognitive Therapy models in treating mental illnesses. This statement also supports the view that education, support for patients and families and other resources likely also help patients develop the best attitude to treatment.

Cohen’s profession was also a hindrance to his treatment. The chapters that describe his life as a journalist, specifically a television news producer in the 70’s and 80’s reveal the true biases of that world at that time. Also, journalism certainly did not help Cohen develop the attitude that he came to realize was necessary for him to have to best manage his illness in the context of a very full life. Cohen lied to remain at work and to advance. In fact, he was advised to do so by the few friends who knew he has MS:

“So much of what I had learned about journalism had to do with basic honesty and full disclosure. Yet there I was, about to perform a dishonest act to inaugurate my relationship with an institution built around honesty.” (pp. 63-64)

We follow Cohen through the life stages of moving into a committed relationship, having children, moving out of Manhattan – all in the context of ever worsening Multiple Sclerosis. In case you’re thinking, “Well, now it gets boring,” Cohen’s life takes another twist when he learns he has cancer. In final chapters, Cohen considers how his children and his wife have managed his worsening and developing illnesses. His account of these life struggles is nuanced for the reader by the fact that Cohen and his wife, Meredith Vieira, are giants in the United States world of journalism and so much of their coping is ultimately in the public domain. Cohen emphasizes that it is only after many years that he finally realizes that resilience is fostered by an active role in his own treatment:

“The moment was sobering. A new era had to begin. Coping evolves. It was time to take charge and stop making a monkey of myself. There is work to be done. Trying to sneak away from the truth worked for a long time but now seemed foolish. Adulthood must be learned anew from time to time.” (p.233)

(The page numbers are taken from the Harper Collins first edition of this book, published in 2004, New York.)cropped-cropped-photo-3.jpg

A book that rethinks cancer

Book: Malignant Metaphor: Confronting Cancer Myths by Alanna Mitchell (Toronto: ECW Press, 2015)

Cancer is one of the mythological illnesses and in this spare, riveting book Alanna Mitchell confronts the myths that surround cancer diagnosis, treatment and living with cancer as few writers have done. To do this she uses the premise provided by Susan Sontag in Illness as Metaphor (New York: Farrar, Strauss and Giroux, 1978.) Sontag’s premise is that we build mythologies around illnesses we don’t understand. Cancer is one of these illnesses.

This book is personal. Mitchell follows her brother-in-law’s and her daughter’s journeys with cancer. With dignity and an open mind, she examines the fictions that persist around the diagnosis of cancer and, in particular, that nagging view that, if you have cancer, then you’ve done something wrong. Most poignant was Mitchell’s account of her daughter’s brush with cancer and the myths she immediately encountered:

“Above all, I felt guilt. That it ought to have been me…That I ought to have been able to forestall this somehow…I replayed every second of her childhood that I could remember, wondering what I had done to fail her in this way.” (p. 155)

What is most important about Mitchell’s book is that the science is so thoroughly explored. She does a very credible job of examining what science exists around the homeopathic and naturopathic treatments of cancer. However, she also examines the most prevalent metaphor that health care systems and providers use in relation to treatments: the metaphor in which treatment is likened to conflict or a war. We have all heard those metaphors, even use them – fight cancer, combat heart disease, an arsenal of treatments.

How does the war metaphor benefit the treatment of cancer? Does it give us the energy to cope with the rounds of investigations, treatments, hospitalizations? Perhaps it does. What this metaphor does not do, however, is help us to understand the randomness of cancer in many cases. Cancer sometimes strikes out of the blue. We all know people who have no family history of cancer, who live healthy lives, eat organic food, exercise, and still get cancer. Do you notice how we seek reasons for these anomalies? Do you see how strongly we believe the myth that science will find all the answers – even when we know there are questions we haven’t even considered?

For the question Does science have the answers? Mitchell makes this point:

“The point is that if you think you can pinpoint the cause, then you can fool yourself into thinking that you can avert the cause. It’s deeply egotistical. It’s life played as a grand insurance policy. Our myth-making around cancer stems from the same impulse. Because we don’t know exactly why most of it happens, we weave a makeshift wisdom around it, a false prophet, which seeps into the common story and feeds our hunger to understand why. The guilt is a byproduct, a way to assign blame and seek absolution. It’s a lesser evil than the forces of randomness. And it gives us the illusion of control.” (p.163)

Mitchell posits that other metaphors might serve us better in our quest to understand our lives in the context of cancer. To me, this may be where other knowledge: literature, philosophy, faith may serve us better in managing disease. We speak of “random acts of kindness” but aspects of all illnesses are random, too.

Think about how so many good events in our lives are seen as serendipitous: falling in love, meeting a best friend, finding the “perfect house”. We don’t seem to agonize over why these things happened. We have a view that the best things are often random. Why can the worst things never be random?

In medicine, our excessive reliance on science (e.g. double blind trials, evidence-based practice) blinds us to the realities that we might confront illness more effectively if we remembered that the root of science is not just science. As Mitchell states: “…dream, experiment, fail and then dream again.” (p. 184)

Trying to understand cancer, or any illness, scientifically fails to help most of us live well with illness. The only thing certain about our lives is death. As the illnesses that will kill us develop, we need metaphors that feed our souls as well as sustain our physical comfort. Death is not our fault.

Book Review – “Universal Foam” by Sidney Perkowitz, Anchor Books, 2000

I cannot even remember how I found this book among the Ottawa Public Library’s lists, but I did and then was attracted to the subject as a matter of science. This is an informative book on an interesting subject that can easily be read on a snowy afternoon – preferably with a cappuccino. You will learn more about foam in those few hours than you ever thought possible. You may even bubble over with enthusiasm and spend another afternoon considering some chapters in greater detail or looking up Perkowitz’s references.

This is a witty, somewhat playful book and it encourages the reader to do what I just did above which is only excusable as an illustration of the properties of foam and its universality in our lives. Perkowitz begins with a description of the basic science of foam and then proceeds to illustrate these properties through considerations of types of foam with which we are all familiar. By beginning with familiar types of foam, the reader visualizes foams properties in the context of a substance she knows well – milk foam on a cappuccino or the foam of a mousse or soufflé. For example, the proteins in milk are the surfactant and heating the milk denatures the protein – breaks apart the bonds of a spherical protein such that it “unravels into long coil-shaped molecules” (page 48). I read those phrases thinking, “That’s how that works.”

From edible foams, Perkowitz moves on to such useful foams as shaving foam and foamed plastic and, again, we learn more properties of foam as they are illustrated in these substances. Then, however, the reader is brought into one of the main premises of Perkowitz’s book: understanding foam helps us to understand life, since the cellular matrix on which all life is based highly resembles foam.

From this consideration of how foam mimics the cellular matrix, Perkowitz begins a discussion of the foams that are present in the earth’s structure: pumice, sea foam. These descriptions allow the reader to consider the “global role of foam and its ties to the innermost and outermost processes of our planet” (page 145).

Perkowitz’s final consideration is of foam beyond the boundaries of earth into our solar system and galaxies beyond. I was fascinated by his account of how panels of aerogel will be deployed by the Stardust spaceship to trap small particles from the coma of the comet WILD-2. These small particles, we are told, “will slam into the aerogel at speeds of 14,000 miles per hour. Among all known materials, aerogel is the only one that can bring these tiny hyperbullets to a screeching halt with little damage.” (page149) Those few trapped particles will be studied to help us learn more about the cosmos.

Apart from the value of foam in learning about the cosmos, Perkowitz ultimately discusses how even the universe is structured like the bubbles of foam, how quanta are related to foam and “how the big bang theory views the cosmos as an expanding bubble of space and time that is now billions of light years across.” (page 157). A physicist himself, Perkowitz often reminds the reader of the tremendous contribution of the 20th century’s iconic physicist, Albert Einstein. Perkowitz’s book, however, brings to mind Einstein’s quote, which example this book follows:

“The eternal mystery of the world is its comprehensibility.”

Summer Reading Days

As a Child Psychiatrist, I read many books for children and adolescents so that I have books to recommend to parents and my patients, or to adults who want to purchase books for children and youth. Summer is the best time for reading and I have two wonderful books to recommend. (Note: If you live in Ottawa, you can find both in the Ottawa Public Library.)

Let’s start with Rules by Cynthia Lord. “Not everything worth keeping is useful” is one of the “rules” that Catherine, the main character of Lord’s book for older children and teens, establishes for her younger brother who suffers from Autism Spectrum Disorder. David. Catherine’s brother, like all people with this condition, has great difficulty understanding and negotiating a human being’s regular day –to- day existence, mostly because of difficulty with that part of our communication which is nonverbal and metaphorical. If only we meant what we said…

Catherine struggles between her anger about how David’s condition interferes with her “normal” life and her anger at neighbours, friends, teachers, anyone whose treatment of David (or any person with different abilities) is guided by prejudice or pity rather than common humanity. To assist David as he progresses in his interactions with others, Catherine develops “Rules” for David for social interactions and day-to-day situations.

Anyone who has ever lived with stigma can relate to Catherine’s longing for a “normal family life”, and especially a “normal brother”, as much as she loves David. Rules draws the reader in since we realize that, as Catherine tries to make friends with her new next door neighbor, she also has difficulty maintaining the high standards that she sets for others. As difficult as it is for her to make friends with someone “normal”, she becomes close friends with someone else, although she does not realize this.

A Newbery Honor Book, Rules also earned the Schneider Family Book Award. This is an award to honour an author or illustrator for a book that “embodies an artistic expression of the disability experience for children and adolescent audiences”.

Ultimately, Rules is not just a book about which rules to keep, but also which rules must be broken. Because, as we all have to learn: Not everything worth keeping is useful.

The second book, Kingfisher Days by Susan Coyne, would be a great book to read aloud in the evening on a family vacation. The main character, the author herself, is five and so even younger children would enjoy the story. Anyone older will have an opportunity to remember what it was like when they were five years old. They will also have an opportunity to remember those adults who brought  wonder and magic into their lives. The perfect summer book, Kingfisher Days is, on one level, a book about the pleasures of a Canadian summer spent at a cottage on a lake. It is also the story of the author’s relationship with her next door neighbor at the lake and how it is mediated by a fairy/wood nymph/elf named “Nootsie Tah”. Susan finds a stone fireplace under a hedge between her cottage and her neighbour’s. Her father tells her that the fireplace is left from a cottage for elves that burnt down. Susan begins to leave small gifts and pictures for the elves and one morning, she finds her first letter from Nootsie Tah, a fairy who writes to Susan, “I am very beautiful and a great princess,” and signs herself “Nootsie Tah, Princess”. After a second letter arrives at the stone fireplace, Susan dictates her own letter back. Susan discusses her correspondence with her neighbour, Mr. Moir, who supplements the letters with readings about fairies from such sources as Shakespeare and Keats. All summer long letters go back and forth between the fairy princess and the human girl, who finally tells the princess that she loves her. As everyone knows, love sets fairies free and Nootsie Tah is thrilled to return to her mother in far-off Peru. Susan is sad, but her friend’s leave taking makes it possible to close the summer adventure for Susan.

In introducing the book, the author tells us, “This is the story of a remarkable friendship, which began when I was five years old, and has nourished me all my life.”

Both of these books are about relationships, and how we must cultivate them but they are also about the metaphors and symbols that help us to understand not only what is literally true, but true. This is the best kind of book to read, and not just in summer.