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Poetry and Medicine: Prize Winners

20 Jun, 16 | by cquigley

 

image1

In April I attended the 7th International Symposium on Poetry and Medicine where the 2016 Hippocrates Awards were announced. A fascinating day, the programme included critiques on Philip Larkin’s The Building, Celia de Freine Blood Debts, Mary Kennan Herbert’s Skin Man series, as well as a presentation on Poetry, Psychoanalysis and Ageing, and a discussion around the evidence for the benefits of poetry for patients. Poetry readings of course dominated the proceedings, not just from winning and commended poets, but also sessions from Rafael Campo and Wendy French. A day truly rich in poetry, it left much to reflect on in terms of the potential for the genre to impact on the illness experience.

Winners for the three categories within the Hippocrates Awards are featured below. These and many other poems selected by the judges are available in the 2016 anthology.

Poems very gratefully reproduced by permission of the poets and the Hippocrates Prize.

 

2016 Hippocrates Prize for Poetry and Medicine

 

NHS First Prize

Denise Bundred (Kitchiner)

 

A Cardiologist Seeks Certainty

I spread cold gel on a newborn chest

rest the probe on creamy skin, angle

between ribs, rotate to find a heart

no larger than the tiny fist

pushing me away.

 

Two dimensions defy translation into three

as I locate chambers

amid the maze of vessels.

A millimeter of movement and the image melts

to snowstorm on my screen.

I re-trace arcs of ultrasound to relieve

the twist of doubt.

Adrenalin dries saliva as I strive to decide

whether the aorta arches

to the left or right.

 

The nurse checks the prescription

against an ampoule, initials in black ink

secure in her certainty of drug and dose.

 

The surgeon weighs my words

to determine his incision

shape his operation

as the incubator trundles towards theatre

escorting mother and the nurse.

 

I resolve inconsistencies

into diagnosis, wipe the sweat

from my hands, write my notes;

make my decision.

 

 

Open First Prize

Owen Lewis

 

At Tribeca’s Edge

This evening, I walk to the water where the Hudson opens

itself to the sea, and the sea with its rough cross-currents

is in the air and in the light—the light spectacular, clear,

illuminates the buildings of Newark across the water-way

with gold. The shimmering gold at their backs, they gather

to watch the harbor—the skiffs, prow-high, skip like kids

on a great lawn, a run-away pair braid ribbons of bridal white.

What will I tell my colleagues, gathering in a nearby auditorium?

 

I am thinking of my students, this first evening of Autumn,

young doctors eager with learning, still saddened by the sick.

The best are afraid. They’ve heard their voices tired, darkened

and hoarse. A ferry glides by, its wake spilling the embankment,

so close it seems we must hitch a ride, step in—and the light

between the distant buildings prying free, the sails opening with light.

 

 

Young Poets Prize

Catherine Wang

 

Six pills

Spread out in line like a
formal salute, phrased carefully on
the glass dining table.
Prednisolone coated in
white powder
as
bitter as a serrated edge. Mycophenolate
always stuck to my tongue,
a thick bullet. Then,
Esomeprazole and Hydroxychloroquine
coated my
insides
with chalk. I swallowed Calcium,
Vitamin D, just to ensure
that my thinning bones
would not crumble
like wet
paper.
There is nothing greater than the
drama of the human body,
its desires, indulgences.

 

Fevers and rashes. There was so
much that sixth grade
science could not
account for.
Lupus
was not a model disease, not a
display easily shown on brown
and pink plastic organs.
I embraced the
liberties of
ignorance,
deciphering my disease through its nocturnal
whispers. Pushed by the wind’s
warm muscles, I probed
the orange membranes
of streetlamps.
I
traced the moon’s breath, lingering on
the black glass of the sky.
Six pills spread out in line.
Head tilted back, I was grateful
for the silence,
for the empty taste of air.

 

Copyright  © 2016 the individual poets.

More information, including readings and excerpts from winning and commended poets, can be found here.

 

Check out the poetry and prose pages in the current issue of Medical Humanities

 

 

Film Review: stories from Arab women during the Spring Revolutions

17 Jun, 16 | by cquigley

 

‘Our oath’ short film, 2015, directed by Laura Finney

I was intrigued and moved by ‘The trials of Spring’, a documentary film depicting the fight of Arab women during the Spring Revolutions in 2010 (http://www.trialsofspring.com/). The film portrays heart-felt human stories of women from Syria, Yemen, Libya, Bahrain, Tunisia, and Egypt.  Filming took place over three years focusing on the stories of nine women from these six countries fighting for peace in a time of war.

One of the most thought-provoking shorts in the film was ‘Our oath’. Through recorded interviews with Dr Nada Dhaif, a practicing dentist, we follow her fight with the ruling regime in Bahrain in 2011. When the demonstrations broke from the Diamond ‘Lolouah’ Square in central Bahrain, the government launched a brutal military response, resulting in several dead and injured casualties. Dr Nada along with doctor colleagues set up field-hospitals to provide essential basic life-aid support to the casualties. Dr Dhaif states ‘I could not believe what was happening, it was so unexpected. I could not process it mentally. What happened was against our religious, social, and cultural traditions. The sole motivation behind our action was our professional medical duty in practicing the Hippocratic Oath that urges doctors to uphold certain ethical standards:

‘I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism’ and

‘I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm’
Dr Nada was soon confronted by accusations of ‘plotting to overthrow the ruling regime’ and duly arrested.

Dr Nada: how did you react to this unexpected turn of events?

‘During my detention, it all felt unreal, a nightmare that I will wake up from. I did not stop to think or question my course of action. I was isolated and did not know what was happening outside. There were other women there too from various professional backgrounds’
After two months in jail, Dr Nada was sentenced to 15 years in prison in a military trial.

Following her sentence, international Human Rights and professional medical organizations from Ireland and elsewhere lobbied for her release. There was significant pressure from the British and American embassies in Bahrain. The news reached international press, after which Dr Dhaif and other doctors were released from prison.

The harsh jail experience proved to be a wake-up call for the doctor, wife and mother. Dr Dhaif continues: ‘By that time, I realized that my professional and humanitarian duties should extend to provide aid to political prisoners and their families as many of them suffer from mental illness and in dire need for care and mental rehabilitation. I set up an organization- BRAVO– Bahrain Rehabilitation and Anti Violence Organization- for treating citizens who were subject to torture and violence’.

In addition, she founded her own You-tube channel aimed at increasing awareness amongst the Bahraini and Arab communities about mental illness resulting from oppression in various forms and shapes.

Dr Nada: can you tell us more about the current state of your BRAVO organization, and you-tube channel?

‘BRAVO was founded in January 2012, and our work focused on providing physical, mental, and psychological care for victims. In the first few years we were able to provide various types of rehabilitation programs for up to 400 victims per year. But since the end of 2015 up till now, due to escalating risks, we shifted our efforts in providing rehabilitation care programs to the on-line channel. The idea of my YouTube channel “Nada Time” helped us reach out to over 20,000 people viewing the channel, with remarkable feedback’.

Dr Nada’s convictions are apparent in her opinion that change takes a long time, and that she herself might not live to see its impact in the near future.

Credit goes to the film director, Laura Finney in exploring the ideology of ‘peaceful resistance’ in a focused narrative from an Arab doctor’s perspective in as little time as 5 minutes. The film explores candidly the doctor’s role in their community particularly in relation to ‘Human rights’. The doctor is no longer a passive professional caring for a few patients, but indeed a formidable ‘power for change’.
To view the film, you can access the following link

http://www.trialsofspring.com/stories/bahrain
Dr Khalid Ali, Screening room editor

Address for correspondence: Khalid.ali@bush.nhs.uk

THIS IS A VOICE at Wellcome Collection reviewed

16 Jun, 16 | by cquigley

L0081645 'His Masters Voice'. Painting by Franci

‘His Masters Voice’. Painting by Francis Barraud, 1919. Credit:Courtesy of the EMI Group Archive Trust

 

THIS IS A VOICE

Wellcome Collection, 14 April – 31 July 2016

Reviewed by Steven Kenny

 

Approaching the exhibition entrance of THIS IS A VOICE at the Wellcome Collection, it is easy to think the voice is treated as criminal, being contained, controlled and its behaviour segregated from the world outside. Initial thoughts would suggest that it is being acoustically surveyed; with the steady opening and closing of the exhibition door, sound rushes to the exit. Yet its attempts are ultimately futile, the room has been sound proofed, noise restricted from accessing the outside world. On entering the space, grey triangular padded shapes line the walls, detail reminiscent of a kitsch science fiction film from the 1980s. The exposed patterned structures, evocative of the décor of Ridley Scott’s periled spaceship in Alien, enclose you in a warm, familiar hug of nostalgia. Sensing that this space is one visually tread before, it is easy to forget the prestigious institutional context of the exhibition. THIS IS A VOICE, a show investigating the potential of the voice in all its forms, techniques, objects and cultural baggage, is particularly engaging for it knowingly understands such a topic cannot be wholly represented (due to various cultural and language complexities). Yet it does a heartfelt job in attempting to at least understand how the voice as a product, both commercially and non-commercially viable, can be exhibited. Curatorial flourishes can be found everywhere, from the nooks and crannies of seated listening stations to the maze-like paths that allow a gentle flow of avid listeners from one space to the next. From attending numerous shows at the Wellcome Collection I must comment that THIS IS A VOICE is one of the most stimulating and generally refreshing exhibitions to be held in its space.

It would seem that an inner versus outer exploration of the body and the voice is focused on throughout. One telling example of this is immediately apparent in the work Circular Song, 1974 by Joan La Barbara. A half dome like structure hangs from the ceiling, the speaker’s hollow interior pervading the space below with sound. The experience of entering this wall of sound is generally unnerving, a constant and increasingly uncomfortable echo of inhaling and exhaling performed by the artist, breathes all over you. It is nightmarish, a deathly noise that would seem totally apt in the exhaling howls of a victim being chased by a stalker in a nerve inducing slasher film. Sound in this manner is represented as an abject substance, an uncanny emotional pulling of the visitors’ own sentiments to the body and the amplified vocalisation of a body process that now seems one of disgust. Yet this is in direct contrast to Marcus Coates multi-screen film installation Dawn Chorus, 2007, which is silly, funny and surprisingly touching. This room is filled with the fluttering sounds of birdsong, a number of monitors positioned at varying heights depicting subjects in everyday locations comically singing along to each sound created. Experiencing this work initially seemed deceptive­­–I could not understand how both image and sound aligned so perfectly, as though the birdsong was actually being produced by a human lip whistle. Subjects pursed their lips and jotted their heads up and down in perfect alignment. The façade is lifted on reading the work’s description: ‘After recording the dawn chorus with multiple microphones, the individual birdsongs were slowed down to last approximately 16 times as long, which enabled the participants to imitate them, while being filmed’. Yet not knowing these details did not matter as my imagination roamed freely around the space. I observed each subject as one would watch a bird in the wild, mesmerised by its harmonic whistle and merry bouncing of its head.

Words

THIS IS A VOICE at Wellcome Collection, 2016. Credit:Photography by Michael Bowles

Dotted around the exhibition are various textual works, the written word laid bare. Erik Bunger’s wall text I Hearby Command You to Give Voice to These Letters Silently or Out Loud, 2011 was surprising in that it forced an involuntary restriction of my own voice from permeating the gallery. I so badly wanted to shout out loud the words I was reading yet thought better than to add to the already noisy space. Yet on second thoughts maybe that would have made for some interesting spectator reactions. Bunger’s playful register, was paralleled by Mikhail Karikis’s digital prints (photographs by Thierry Bal) Sculpting Voice, 2010, where the artist was photographically recorded pulling various facial gestures. Three prints line the wall in sequence, each exhibiting Karikis’s comically retuned face, made even more comical by the muting of what would probably have been quite a painful or otherwise loud projection of sound.

L0081817 THIS IS A VOICE at Wellcome Collection, p

THIS IS A VOICE at Wellcome Collection. Credit:Photography by Michael Bowles

 

The exhibition saved its loudest and most intriguing work for last. Entering the final room of the show, you would think that you might have woken in a Lynchian nightmare. Best described as an interactive, participatory constructed, sound installation, a lone and somewhat foredooming sound booth, tempts the spectator.

L0081800 Matthew Herbert, Chorus, 2016

Matthew Herbert, Chorus, 2016. Credit:Photography by Michael Bowles

The aptly titled Chorus, 2016 is by the British electronic musician Matthew Herbert, whose work ‘asks visitors to sing a single note within a professional recording booth following a set of instructions. The visitor’s voices are then automatically added to a chorus of voices, including performers and staff from the Royal Opera House, forming an ever-expanding sound installation that plays in the exhibition space and at the Royal Opera House’s Stage Door in Covent Garden’. I entered the space to sing the requested solitary note. Escaping my throat, my voice joined the squeaks, squeals, and sometimes correctly pitched notes above. Noise reverberated violently throughout the room, puncturing the space like a diminished fifth encroaching a melodic passage. The voice in this exhibition is presented as an ever-changing entity, one that is able to attack, calm and arrest.

 

Articles from Medical Humanities on the human voice:

Kelly BD. Searching for the patient’s voice in the Irish asylums. Med Humanit 2016;42:87-91.

Demjén Z and Semino E. Henry’s voices: the representation of auditory verbal hallucinations in an autobiographical narrative. Med Humanities 2015;41:1 5762.

Puustinen R. Voices to be heard—the many positions of a physician in Anton Chekhov’s short story, A Case History. Med Humanities 2000;26:1 3742.

 

Book review: Social Class in the 21st Century

15 Jun, 16 | by cquigley

 

9780241004227

Mike Savage, Social Class in the 21st Century, Pelican, 2015

 

Reviewed by Jacob King, Medical Student.

 

You may have heard about the Great British Class Survey, you may have even completed the Great British Class survey (GBCS) or tried their online Class Calculator. In 2015 Mike Savage and colleagues summarised the findings of this great exploration into British society in their book Social Class in the 21st Century. Launched by the BBC in 2011, over 161,000 people (p.409) replied to a survey assessing an extensive range of factors regarding the lives of anyone living in Britain who volunteered to be heard: your income, your savings, the value of a home you may own, whether you went to university/which university? Who do you socialise with? Do you know a cleaner, a doctor, a student, travel agent, what about an aristocrat or noble? What did your parents do for work? Where are you from? What class do you think you belong to?

It’s almost hard to believe that anyone would divulge all this information, and yet a second wave of data collection has since yielded an additional 164,000 respondents, and millions more have tried the abridged Class Calculator online. Social Class in the 21st Century is an Aladdin’s cave of data for the socially curious, for those interested in what makes British society tick, for the man who wants to know what others presuppose of him, not just the class conscious Hyacinth Buckets of the world (though I am certain she would eagerly paw through its pages of charts too). Through the wealth of collected data, and extensive interviewing, the results of the GBCS made revolutionary revisions to the historic models of class, and what, if anything, could justify these. The book in its whole therefore relates to the analysis of their investigations, the establishing of new class identities and explanations of what qualifies membership to these groups, but importantly, it examines the relationship between each of these factors, and the political ramifications the results may hold for society.

While the authors ultimately conclude that the concept of social class has significant flaws, unfairly stereotyping the bottom of society and justifying the position of those at the top, their work identifies three key qualities which influence social standing. They term these economic capital, cultural capital and social capital. (p.46)

Economic capital: The value of your home, whether you rent, your household income, what savings do you have.

Cultural capital: The type and range of interests you pursue: from visiting stately homes to attending rave parties.

Social capital: The kinds of people, and the range of the kinds of people you know: have you an aristocrat friend, has one of your friends never worked?

On the back of this, the authors develop a new model for class structure based on typical and common groupings of traits expressed through these forms of capital. (p.169) With the greatest showing of each of these traits, the ‘Elite’ class characterises those financially well off with high scores for social capital, consumption of ‘highbrow’ cultures (opera and classical music, for example) and relatively high consumption of emerging culture (social media use, listening to hip hop/rap music). At the other end of the grouping the authors describe the precariously placed ‘Precariat’, who often demonstrate very low household income, low social contact scores, very low levels of the consumption of highbrow culture and low levels of emerging culture. The model is completed with five intermediate groupings: established middle class, technical middle class, new affluent workers, traditional working class, and emerging service workers, each with a different pattern of capital forms.

Throughout the book, the authors consider whether class is useful as a stratification tool. In practice, only one-third of people in the UK believe themselves to belong to a class. (p.367) Interestingly, those with higher economic, cultural and social capital reservoirs are more likely to believe that they belong to a class, and are more accurately able to identify which grouping they may fall into. (p.369) On the other hand, 75% of those with lower levels of capital do not believe that they are part of a social class. But despite popular rejection of class titles, the authors describe evidence of lines being drawn between groups, and argue that the labels are perpetuated “even if only to prompt negative reactions to them”. Key examples include the relationships between the traditional working classes and the ‘benefit scroungers’ below, or the technical middle classes and the ‘posh snobs’ above. Commonly, a person’s job, the way they speak, and even, as evidenced by inflammatory comments made by journalist Katie Hopkins on ITV’s This Morning in 2015, what you name your children indicates social class, and where these lines are drawn. (p. 363)

But, what do these models of class, concepts of capital forms, rejections of a class hierarchy but lines being drawn all the same, mean for our lives? While this book is certainly not a medical text, the conclusions may have significant impact on the state of medicine. In one aspect, doctors as a profession have been widely drawn upon for examples of why capital reserves matter.

We are all aware of the gender pay gap, the concept that women are paid less than men for equivalent work. The GBCS highlights the importance of the ‘social background pay gap’, especially among professionals. The results demonstrate that while many other professional groups experience wild differences in their future income depending on their background, doctors are more or less immune to this phenomenon. Doctors beginning their lives in the most elite upbringings only earn around £5,000 more per year than a doctor from a background where their parents did manual work or did not work (£80,226 versus £74,915). (p. 202) Compare this to lawyers (£86,363 versus £65,583) or company CEOs (101,052 versus £83,467). There is not enough room in the book to speculate on why this is the case, but perhaps an industry monopoly, and concrete training programs could offer explanation for why strong social networks, varied interests and comfortable finances do not impact on doctor’s career progression notably. The implications of this exploration of social class have significant (at least proven financial) impacts on the future lives of individuals.

We are treated to a handy metaphor for social mobility. When climbing the mountain that is the social/economic ladder, those who start off near the top of the mountain do not have to climb as far. They have the resources, experience and ability of those around them to support the short climb to the top. Those who start off at the bottom have significantly further to climb, and lack the experience or resources with which to climb. To emphasise the point, Social Class in the 21st Century also takes us through how whether we go to independent or comprehensive school, which university we go to, which course we do, and where we live significantly predicts future social standing.

Reading this book – especially the targeted interviews which provide delightful insight into the very real lives of the anonymous subjects – one leaps to think of people in our own lives, maybe a patient, or family member or friend. You think about their start in life, what jobs they have taken, how much their house may be worth, what are their interests, how does all this link? Aside from the direct implications that this work reveals for the medical community, doctors and patients, and broad examples of health experiences, this work is not a traditional medical piece. Yet, the profound impact that sociological relations have, not just on the day-to-day observable doctor-patient relationship or even medico-sociological phenomenon: access to health, quality of life, health behaviours, attitudes to health and others, but also in shaping everything else in between. The structure of society is linked so fantastically to health, wellbeing and illness, through education, employment, family ties, that the direct health implications that result from disruption in any one of these, could be considered a precursor for the occurrence of poor health and the ultimate success of outcomes.

I relay the conclusions of Prof. Mike Savage and others; despite the quirks and quandaries a sociology study’s methodology faces, the importance of this understanding and how it shapes every aspect of a life is important to appreciate. From our medically tainted view of this book, we can only conclude that our status as doctors fundamentally and inescapably plies us with a high degree of social, cultural and economic capital. Our patients more often than not will not be similar. It is our job then to ensure that social status, presuppositions of ‘our kind’ is in no way a detriment to the clinical relationship. Perhaps more importantly, on a political note, appreciating capital in our patients and the overwhelming effect our early years circumstances has on our social networks, on our interests, our finances, and how this frames all of our interactions is vital to understanding the context of a patient’s life.

Social Class in the 21st Century is a book with beautifully broad scoping commentary, revealing a glimpse into the nature of society, and opening significantly more questions than attempts were ever made to provide answers.

 

Other articles that may be of interest:

Daniel Holman and Erica Borgstrom. Applying social theory to understand health-related behaviours. Med Humanities 2016;42:2 143145 

John Harley Warner. The humanising power of medical history: responses to biomedicine in the 20th century United States. Med Humanities 2011;37:2 9196 

Claire Hooker and Estelle Noonan. Medical humanities as expressive of Western culture. Med Humanities 2011;37:2 7984 

Kenneth M Boyd. Disease, illness, sickness, health, healing and wholeness: exploring some elusive concept. Med Humanities 2000;26:1 917 

 

The Reading Room: The Violet Hour – Great Writers at the End

10 Jun, 16 | by cquigley

 

the violet hour

Katie Roiphe. The Violet Hour: Great Writers at the End. Virago, 2016

 

Reviewed by Professor Robert C Abrams, Professor of Psychiatry, Weill Cornell Medical College, New York

 

A central premise of Katie Roiphe’s The Violet Hour is that the awareness of approaching death is a milestone we all will face at some time and in some form. From there, Roiphe explores how the moment of awareness, the awful prognosis, was confronted by each member of an august selection of writers and thinkers. But it is not only that first acute glimmer of understanding that Roiphe examines, since dealing with death more often than not involves a lengthy, even a lifelong, prodrome, an unwelcome perception that appears slowly and gathers to invade consciousness.

Roiphe’s subjects are persons of uniquely substantial depth, creative visionaries in their own fields—Susan Sontag, Sigmund Freud, John Updike, Dylan Thomas, Maurice Sendak. An interesting aspect of the book is that, when the subject is death, these luminaries are just as avoidant and vexing as the rest of us. One is at first tempted, naively, to believe that what these individuals have accomplished in their lives ought to ease the pain of anticipated death, or enable them to articulate the experience in a way that leads us to greater insight. However, intellectual or artistic stature does little to soften the impact or illuminate the journey—at least for this select group. Instead, Roiphe shows how the nearness of death strikes with terror at one’s narcissistic heart and can derail the psychological homeostasis of almost everyone.

What can be derived from the accounts of these great thinkers is therefore not clarity, but an analysis of how they actually felt as death loomed. In a way, Roiphe’s writers coped with death much as they had lived, in all their contradictory ways. Like strands of spaghetti Bolognese, each story line branches out and swirls around in so many messy directions that the themes can be difficult to untangle and trace. (In fact, compared with their highly variable, tortured pre-death processes, the actual moment of death for these writers seems to have been uniformly anticlimactic; all the complicated action has taken place earlier). So it is that we are shown how Dylan Thomas dreaded death but died in a self-destructive orgy of alcohol and Benzedrine, the culmination of years of punishing abuse of his health. John Updike, on hearing his dire prognosis, turned immediately to poetry, for him a reliable source of consolation, and he kept at it, creating what some have considered his finest work, for as long as his strength allowed.  Susan Sontag did something similar, finding solace under the cover of the intellectual constructs that were her hallmark, except that she fiercely refused to give in or let go; she marshalled all the intellectual force at her command to master her illness and survive it­­, until she simply fell away. Freud was magnificently inconsistent: Freud, the ultra-rational doctor who once famously insisted that “a cigar is just a cigar” could never give up what he knew was rooted in primitive oral gratification and thus knowingly died of smoking-related cancer. Maurice Sendak, who seemed to have imbibed angst prenatally, was completely preoccupied with death and had been preparing for it nearly all of his life.

But thinking about death when it is not proximal is very different from grappling with it in the moment. Death is something for other people, never for oneself, until it isn’t. But up to that moment, it is safe enough to wish for death, romanticize it, flirt with it. When death actually does arrive, it is presented as a full-stop but not necessarily a resolution; one dies, not after living but during it, leaving everything that is unsolved, unsolved. Again, these observations would be unremarkable were it not for Roiphe’s notion that the deaths of such hyper-articulate individuals should be exceptionally revelatory. That in the end her characters are merely ordinary humans contending with the direst possible threat to their existence may be in fact the point.

If The Violet Hour can be a dark, depressing read, it is also a brilliant one, framed in stunning, exquisite prose by an artist-of-a-writer.  Roiphe’s introductory synthesis of thoughts about death could easily stand alone as a splendid thought-piece, and there is a touching personal epilogue at the end. But for most of the book the author is rather coy about her own views of death. For that one must look to her casting choices. Starting with a set of 20th century cultural icons who wrestled with the concept of death and left written records and accounts of witnesses to prove it, her chosen characters add up to a grim group of players, John Updike being the sole possible exception. The others are grim, not only because they are dying, but because of the bleakness they have created for themselves.

It is probably a consequence of Roiphe’s selection of characters that there is missing in this book any serious discussion of hope—Emily Dickinson’s resilient little creature with “feathers.” Hope is too effeminate for the likes of Susan Sontag, who preferred to submit to a brutal stem-cell transplant in lieu of gentle palliation because the transplant offered a slim hope of survival. Hope is too shallow and totemic for Freud, who prided himself on tolerating pain with what Roiphe aptly calls “heroic clarity” instead of mind-numbing analgesics. Hope was off the radar entirely for that 20th-century poet-maudit, the personification of romantic self-loathing, Dylan Thomas. But for us ordinary folk, readers who are death-fearing, moderately self-defeating but not quite blatantly self-destructive, some consideration of hope just might be welcome.

In an influential article in the geriatric psychiatry literature, Sullivan succinctly formulated how “hopelessness at the end of life is not simply the absence of hope but attachment to a form of hope that is lost.” [1] Consistent with the writings of Erik Erikson, [2] this view holds that a dying person must deflect mental energy away from the goal of survival, the currency of which has been divested of all value, to some alternative ethos consistent with his life and personality; this should ideally be something larger in scope than one person’s life, some experience or value that will outlast and transcend the individual, such as intimacy, democracy, art, or salvation. In the absence of any realistic point of future reference, redirection of hope becomes the urgent task to be confronted when one is handed a final sentence of death.

Considering Roiphe’s cases from this perspective, she shows how Sontag haughtily spurned everything but survival, and by embracing a losing cause, died sadly, though she left a spectacular record of written reflections. She documents how Freud, who worked until the end, died with little psychological adjustment to make, well aware that he had created an incomparably rich legacy; he also had an heir to his intellectual estate, his daughter, Anna, who was eager to perpetuate it. Only Updike seemed to achieve a meaningful transition; his hopeless prognosis spurred him on to new creative heights and enabled him to return, albeit briefly, to the top of his form as a writer, a peak from which prior to his cancer diagnosis he’d felt he had been slipping. Previously it had been sexual affairs that had seemed to energize his writing; now it was the awareness of death. When he could no longer write, he died.  Neither Dylan Thomas nor Maurice Sendak ever entertained any sustained vision of themselves as surviving, so no such transition applied to them.

Reflecting on the absence of hope in the main body of The Violet Hour should not be taken as a criticism, for Roiphe, by clinging to neutrality and avoiding any position other than that of reporter until the book’s final pages, invites readers to abstract their own lessons from these stories and integrate them in a personal way. And it is fortunate indeed that she does not entirely neglect the critical human need for love, solace and inspiration at the end of life. It had to have been for such a purpose that she cited these beautiful lines written by the terminally ill John Updike:

“To live is good / but not to live—to be pulled down  / with scarce a ripping sound,  / still flourishing, still / stretching toward the sun– / is good also.”

 

References

  1. Sullivan MD. Hope and hopelessness at the end of life. Am J Ger Psychiatry. 2003; 11(4):393-405.
  2. Erikson EH, Erikson J, Kivnick HQ. Vital involvement in old age. New York: W.W. Norton & Company; 1994.

CHCI Health Humanities Summer Institute 2016

8 Jun, 16 | by cquigley

 

 

Sunday 26 – Monday 27 June 2016, 10.00

CHCI Health Humanities Summer Institute 2016

Health Humanities Now

Anatomy Lecture Theatre & Museum, King’s Building, Strand Campus

2 day Conference which aims to gather scholars and practitioners from all over the world in the burgeoning field of the health humanities. By showcasing some of the most innovative and pioneering work taking place in the health humanities today.

This event is open to all, the Standard Delegate rate is £90 with the option to book the conference dinner for £10.

Student Rate is £40 with the option to book the conference dinner for £10.

Registration is required via King’s e-store, you can book your place here

We do hope you will be able to join us.

Centre for the Humanities and Health

Arts & Humanities Research Institute

Faculty of Arts & Humanities

King’s College London

Tel: +44 (0)20 7848 7963

Email: chh@kcl.ac.uk

Web: http://www.kcl.ac.uk/artshums/ahri/centres/chh/CHH-Events.aspx 

First impressions only happen once

7 Jun, 16 | by cquigley

 

Fergus Shanahan

 

Eyes smiling, face beaming, the porter rose from his stool to greet arrivals at the cancer centre, each nervously hesitant, staying close to a supporting loved one. With the confidence of a man who enjoyed being good at his job, he paused for those needing directions, reassured us that we were in the right place for our appointment, and then boomed: “Welcome everyone, and good luck to you all today.”

Good start. After that, we didn’t mind inconveniences like waiting for the single working elevator and felt better about whatever unknowns were ahead. The moment was still fresh when we got to the sixth floor. There, we faced a receptionist unable to switch her gaze from a computer to address us. Detached with jaded eyes fixed elsewhere, her outstretched arm dispatched us to an adjacent touch screen to register. We obeyed but the system insisted on a five-digit address code. Bad enough to be labelled ‘international’ as code for not having acceptable insurance, but not having a zip code was a new stigma. Before we could explain, Miss No-Eye-Contact was on the phone staring at some distant point behind us, then back to her screen with a facial expression that said: “Can’t you see! I’m busy.” Bristling a little, I blurted out my son’s details to demand attention. Without the slightest shift in posture, she confirmed our existence in the system with a few flicks of her keyboard. Progress. Then she left us with the unsettling comment: “Hmm, that’s interesting…take a seat and wait while I check with Accounts.” This is not what patients want to hear as they contemplate the prospect of major surgery. No one wants to be that kind of interesting.

Joe shot a warning glance at me “Dad…don’t be rude with this lady. Don’t lose it!”

Lose it! After 8 months of continual worry and stress trying to steer my son through the complexities and decision-making of a young man’s cancer treatment, I was determined not to ‘lose it’. We were overseas in a different healthcare system for a high stakes operation. They were now in charge and I would just have to play it their way. After all, I wasn’t the patient. I was supposed to be the support. So I stayed quiet. Then, the silence was broken, delightfully so, it seemed to me, when an old woman behind us flatly refused to have anything to do with self-registration. Dismissing the technology with an impatient wave of her hand, she snapped at no one in particular in a brash accent: “I’m not gonna do it, I can’t be bothered with that.”

Miss No-Eye-Contact receptionist had met her match.

While waiting, I imagined myself telling anyone seeking my opinion that professional staff within medical offices and hospitals should heed the little things that comfort patients. I would tell them that little things are important. Staff should know that routine for them is crisis for the patient. I would remind them that there is only one opportunity to make a first impression. First impressions are made up of little things. Little things can make a big impression. If the front office experience is poor, anxiety increases and confidence in the rest of the enterprise becomes more doubtful. In other words, if the dentist’s receptionist is a barracuda, don’t expect much pain relief when you get to the back office.

Then, we heard our name called out and we were on our way into the back office.

The interview with the surgeon was probably over within minutes but it seemed much longer. He began with a firm handshake. Then, sitting beside us not across a table, he spoke confidently in clear, crisp, explanatory sentences. These, he must have repeated on hundreds of previous occasions but it didn’t seem that way. He anticipated our questions and acknowledged our sense of urgency.

In the end, the professionalism of the porter that morning and his memorable welcome was the bellwether for what followed. The surgeon’s skill and experienced team determined what was to be a favourable outcome. But something else made a difference and a lasting impression. To borrow from the poet Maya Angelou:  “…people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

 

Fergus Shanahan, MD, DSc

Professor and Chair,

Department of Medicine,

Director, APC Microbiome Institute

University College Cork,

National University of Ireland

Tel +353-(0)21-4901226  also cell phone 086 280 4881

FAX +353-(0)21-4345300

F.Shanahan@ucc.ie

 

 

The Reading Room: Reading for Health

3 Jun, 16 | by cquigley

 

 

Erika Wright. Reading for Health: Medical Narratives and the Nineteenth-Century Novel (Athens, Ohio: Ohio University Press, 2016)

 

Reviewed by Dr Jane Darcy, Department of English, University College London

 

Erika Wright begins Reading for Health with a timely reminder for Victorianists, quoting Ruskin’s argument about the dangerous temptation of the ‘phenomenon of the sick-room’ for weak novelists. Its lure, he writes, is that illness and dying have probably been for these writers ‘the most impressive part of their own personal experience.’ Ruskin prefers older novelists such as Scott, whose works exemplify ‘healthy and helpful literature’.

Wright seeks to address this nineteenth-century preoccupation with disease, together with the broader epistemological question of what constitutes health. She sets herself an ambitious argument: to re-examine a wide range of texts by canonical writers (Austen, Charlotte Brontë, Dickens, Martineau, Gaskell) using a new theoretical framework, ‘reading for health.’ She argues that the language we use to theorise disease narratives in the traditional novel assumes a ‘therapeutic’ model, relying exclusively on ‘a reading of crisis and recovery that imagines health as the end of beginning, as the absence of action.’ We should rather, she suggests, consider such writings in terms of a ‘hygienic’ model of ‘maintenance and prevention’. This new way of reading, she argues, will  ‘challeng[e] our sense of order and temporality, setting and metaphor, point of view and voice.’

It is a large and controversial claim, not least because it depends on examining, in Wright’s words, ‘narrative strategies used by novelists and medical writers when trying to preserve, promote, and define health’ [my italics]. This forces her to suggest that the nineteenth-century writers of her study are consciously subscribing to a new and, to my mind, not entirely lucid theoretical framework within which they should be read. A further problem is that in seeking to cover so broad a range of literature, the working-out of her suggested framework in practice can read at times as over-simplified and over-determined.

Her first chapter, for example, is entitled ‘Jane Austen’s Plots of Prevention’. Using and Thomas Beddoes’ Hygeia (1802-3) against William Buchan’s popular Domestic Medicine (1769), she argues that the former ‘enacts a subtle but important shift from cure to prevention.’ The implication that Beddoes was the first to write on the importance of diet and exercise in health maintenance, however, ignores centuries of medical writing about the significance of non-naturals (air, sleep, food and drink etc). From here her focus on Sense and Sensibility (1811) is inevitably narrow. ‘Austen targets negligent parents’, she writes. Well, yes and no. Negligent parents are a useful jumping off point for stories, just as much as they are in fairy tales. She is right, however, to draw attention to Marianne Dashwood’s dangerous cultivation of grief. But while Wright offers sensitive reading of some of the novel’s language, there is no discussion of that key eighteenth-century notion, sensibility. The ‘sense’ and ‘sensibility’ of Austen’s title may suggest a simple binary, but the words are of course cognates, and the novel offers a subtle exploration of the need for both sense and sensibility (the characters who lack sensibility’s gift for compassion are revealed as unpleasant materialists). Most worrying, Wright argues that ‘All of Austen’s novels have, to varying degrees, embedded narratives that function as warnings.’ Mansfield Park she later writes, is ‘teaching us something else. She is instructing us not to improve but sustain … not to cure but prevent.’ She is on thin ice here with literary scholars who will surely bridle at the suggestion that Austen is fundamentally a didactic writer.

Again one of the difficulties of Wright’s range is that she focuses exclusively on physical health, avoiding the vexed issue of the mind-body-spirit relationship. ‘We are encouraged,’ she writes, to see Mansfield’s Fanny Price ‘as a struggling preventionist.’ Apart from making Fanny sound like an unsuccessful apprehender of smugglers, this misses Austen’s skill here in the extraordinarily acute psychological portrait she gives of sustained unhappiness rooted in childhood. There is a careless misreading too. Henry Crawford doesn’t invite Maria Bertram to ‘slip dangerously over the ha-ha’. It is not the ha-ha – that feature of fashionable landscaping – but the symbolically loaded locked gate into the ‘wilderness’ that Crawford encourages the unhappily engaged Maria to slip round.

Dickens offers plentiful examples of diseased individuals, of course. Wright in the next chapter focuses on Little Dorrit and metaphors of quarantine. She also considers less familiar material: her subsequent exploration of Harriet Martineau’s novel Deerbrook (1839) and memoir Life in the Sick-Room (1844) is a welcome one. Her argument, however, for ‘the omniscience of invalidism’ is flawed by an imperfect understanding of narrative theory. The invalid can indeed occupy an important place as a story’s observant outsider figure, but this is far from making her an omniscient narrator. Wright is on safer ground with her discussion of the figure of the newly professionalised doctor in Gaskell’s writing and references to Victorian fiction’s most famous doctor – George Elliot’s Lydgate in Middlemarch.

Wright teaches family health at the University of Southern California. Her medical expertise perhaps allows her to assume in her readers a full grasp of the history of medicine in the period Reading for Health covers. It would have been helpful for non-specialists, however, had she set her discussion of preventive medicine in the wider context of evolving medical understanding across this period. There is one reference, for instance, to humoral medicine, but no mention of how that ancient model of human physiology had been comprehensively replaced by Enlightenment understanding of the nervous system. Above all, Reading for Health, however, is about story-telling. Wright follows Rita Charon in holding great store by its therapeutic powers; indeed her afterword comes to rest almost exclusively on Charon’s work. It is without doubt an appealing position, but a detailed critique of the claims for narrative medicine would have added sharpness Wright’s argument.

 

 

The Screening Room: old age, loneliness and cinema

31 May, 16 | by cquigley

 

Loneliness, and Belonging in the Age of Photoshop

Short film, directed by Amjad Abu Ala

 

Review by Professor Robert C Abrams, Professor of Psychiatry, Weill Cornell Medical College, New York

There is a world of life portrayed in the few brief minutes of the poignant but joyous short film, ‘Studio’, by Amjad Abu Ala (in Arabic with English subtitles).  The film is an affecting portrayal of loneliness in old age and the restorative grace of fantasy.  Through its brevity and intensity it delivers the kind of impact one feels from a tightly crafted short story, where there are no extraneous words or gestures and everything tells.

‘Studio’ opens as a man in late middle age stares intently ahead:  More on him is to follow later.  The scene shifts quickly—as it must, since this film runs for barely 8 minutes–to a view of a photographer’s portrait studio, followed in rapid succession by several of the photographer’s clients posing against a neutral background. They comprise a random but somehow representative sample of humanity. The photographer himself is introduced as a kind of hipster-businessman, a young man immersed in the photo-technology in which reality can be wondrously manipulated.

First on deck is a young woman anxiously fretting over her appearance, followed by a shy little boy, with abundant budding confidence, who seems destined for a happy life surrounded by a loving family.  The subsequent characters are mostly young people.

Eventually the older man returns, this time with a peculiar request.  He asks the photographer to replace the patriarchal figure in a family group portrait with an image of himself.  The wife, son, daughter, and grandson in the original portrait are now to become, with a couple of clicks on a mouse, his new “family.” But the old man encounters a technical problem: for such a momentous transformation, the background of his own ‘family photo’ must have exactly the right color and texture before it is ‘photo-shopped’ into the collage. Like everyone else, however, he must settle for what is available.

That the loneliness of old age is the principal theme here is readily apparent, and one appreciates how it can surpass in its depth of suffering the anxiety of younger adulthood, exemplified by the self-preoccupied young woman. In his innocent appeal, the old man manages to persuade the skeptical young photographer to go along in altering reality.

The older man’s stance evokes a particular passage from Kazuo Ishiguro’s celebrated novel, Never Let Me Go, where the protagonist asserts that if, nearing death, you have no happy memories upon which to reflect, it is justifiable to “borrow” them from someone else and regard them as your own.

‘Studio’ is also a story of the photographer—revealing as much about the observer as the observed.  The photographer does not seem to think of himself as an artist, and that he is primarily in business is emphasized by shots of the window of his studio featuring advertisements for his services.  The photographer, who starts out with a brisk “time is money” stance, evolves over the few minutes of the film, moved by the pathos and urgency of his client’s request.  When the photographer is able to identify with the older man on a human level, the request to construct an imagined family no longer strikes him, nor ourselves the viewers, as outlandish.  Perhaps the photographer considers whether the older man could be widowed, grieving, estranged from or abandoned by his “real” family, and there is nothing laughable or ironic about created families.

The young photographer also appears to have realized that his work, whether intended as art or as commerce, has the potential to console. The healing effects of art are thus implied, as is the possibility that the old man can be immortalized in the finished photo: that product now exists, it is real, and it will stand forever as proof that he was once the progenitor of a loving family.

By end of the film the photographer’s smile (now he’s part of the portrait too) reveals his feeling of kinship with the older man. They are both in the business of life, though at different phases. Two lives have now been altered by the clicks of that mouse.

After the old man carries his treasure, the portrait of his “family,” through deserted streets with high, whitewashed walls that further speak to loneliness, the film closes with a few unforgettable lines about the principal dread of old age, loneliness. In common with physical pain, it is felt most keenly at night when there are no moderating distractions.  “When sleep refuse…/my eyes stay awake. /even that shadow. Left me alone, /Please shadow. don’t leave me alone.”

To view the film, please access https://vimeo.com/52411016

Address for correspondence: rabrams@med.cornell.edu

The Reading Room: Salka Valka

27 May, 16 | by cquigley

 

Salka Valka by Halldór Laxness: she needs to be alone

 

Reviewed by David S. Baldwin, Professor of Psychiatry

Clinical and Experimental Sciences Academic Unit

Faculty of Medicine, University of Southampton, United Kingdom

Email:  dsb1@soton.ac.uk

 

Born in Reykjavík in April 1902, Halldór Guðjónsson (he changed his name to Halldór Kiljan Laxness in 1923) lived through almost the entire twentieth century. Raised in an isolated and traditional society, he travelled widely and embraced cosmopolitan modernity, though retained an essentially Icelandic identity. In early life Laxness adhered to staunch revivalist Catholicism, then embraced socialism for thirty years. He subsequently espoused ecological and pacifist causes and addressed philosophical questions reflecting an interest in humanism and Taoism. But the principal achievement of Laxness was the authentic portrayal of sympathetic but struggling characters that symbolised the determined aspirations of the Icelandic nation and marked its long path towards eventual independence from colonialist Denmark (1).

 

Laxness travelled to America in the 1927 summer intending to become a Hollywood screenwriter. Writing to his then wife Inga at the end of that year, he described work on a film script provisionally titled Salka Valka (or, A Woman in Pants): the eponymous protagonist is described as ‘tall and strongly built’ with an expression encompassing ‘rustic virginity, dare-devilry, primitive charm’, and ‘dressed like a fisherman: wide pants, the boot-legs reaching up over her knees, a pipe in her mouth’. The script reflects contemporaneous Freudian concepts of human sexuality and is redolent with surrealist images, such as the final scene in a lover’s cottage where Salka lingeringly unfolds and kisses the leather straps of an Icelandic whip (often made from skin of bull penis) and Laxness imagined the cross-dressing Swedish actress Greta Garbo in the title role (1). Not surprisingly, negotiations with MGM floundered so the script was transformed into a two-part novel: the first manuscript was written whilst visiting isolated Icelandic fishing villages, the second was completed in cosmopolitan Weimar-era Leipzig. These were published a year apart with the support from the national Cultural Fund: the first (O Thou Pure Vine) was well received, but the second (The Bird on the Beach) was chastised by conservatives for its perceived lampoon of boorish ‘upper class’ motivations and criticised by progressives for its caricature of labour movement infighting – the Communist Party leader suggesting Laxness approached socialism as an idealist, with only a bourgeois understanding of the workers’ struggle (1).

 

An English translation of the combined parts of Salka Valka was published in 1936. The English language version has been out of print for many years, but Guðny Halldórsdóttir kindly lent me her copy, which was published in 1973 following revision by her father (2). A previous review commended its saga-like objectivity and clarity, and the masterful portrayal of down-trodden characters whose local quotidian travails seem emblematic of wider persistent human suffering (3): another account praised its Christian symbolism and careful balance of honourable parishioners and devious villains on both sides of the class struggle (4). The themes reflect the author’s perennial concerns with the nature of love, position of women, role of the intellectual, and the lot of common people: many chapters are full of visceral emotions and disturbing sexual acts perpetrated against young women. In a notebook Laxness described his wish to provide ‘tragic perspectives on the incomprehensibility of human feelings’, perhaps drawing on his desolation, anguish and guilt at the end of an affair with an Icelandic woman whilst living in America. But neither review has considered how the progressive emancipation of Salvör Valgerður (‘Salka Valka’) – as she first becomes a prominent local activist, then distances herself from the competing attentions of aggressively preying or dependently needy men – may reflect a growing awareness of her own sexuality.

 

The novel starts with the mid-winter night-time arrival by boat of eleven-year old Salvör and her unmarried mother Sigurlína at the run-down fishing village of Óseyri. The daughter disembarks first and reassures her mother, ‘in a low deep voice’ which suggests that of a man. They are grudgingly offered a room for the night at the Salvation Army hostel, but the next day their destitute status is acknowledged but not addressed by the local storekeeper, rector or doctor. They return to the hostel and fall prey to the impulsive but persuasive drunkard Steinþor Steinsson, who leads them towards ‘Marbud’, the home of his elderly aunt Steinunn and almost-blind uncle Eyjolfur, where they are offered lodgings. That evening Salvör tells her mother that whilst she was outside Steinþor had ‘grabbed hold of me here and here, and here’, and ‘whispered some stuff in my ear’ but Sigurlína responds inadequately, by asking for mutual understanding between ‘two women’, a response which has a fatal consequence. During the night Salvör is woken by the sound of tussling in the bed, as Steinþor forces himself on Sigurlína: he is repulsed, but only after he whispers a proposition which makes her recoil ‘Almighty Jesus, no! You know you can’t ask me to do a thing like that’. Later, whilst lying awake, Salvör realises she had often lain alone at night whilst her mother was absent, and for the first time appreciates she will have to rely on herself for her future safety: the narrator commenting ‘perhaps one really had nobody but oneself’.

 

The first part ends at dawn on Easter Day, when Sigurlína is found drowned, ‘a little grey oblong piece of flotsam which had been washed up on the sand’. This suicide is the result of a long process which includes remorse for the relationship with a married man which led to pregnancy with Salvör, regret for a subsequent series of damaging sexual liaisons with exploitative men, persistent grief following the death of her two-year old son Sigurlinni from scrofula (tuberculous cervical lymphadenitis: it is later revealed that Steinunn lost many children at Marbud to the same illness), a demoralizing awareness that Steinþor had once again attempted to force Salka into a sexual relationship, and acute anguish following a second desertion by Steinþor, just a few days before their hastily-arranged ‘Hallelujah Wedding’ scheduled for Holy Saturday. Her fragile personality could not withstand such prolonged adversity, without unconditional support from her daughter for whom ‘her mother’s weeping no longer went so deep to the heart as it had done’. During her testimony on entry into the Salvation Army two years before, Sigurlína had told the Congregation of her intention to commit suicide whilst pregnant with Salvör, but attempts at spiritual consolation by vigilant fellow Congregationalists following this nuptial desertion had made no impact: and the position of the often-derided Sigurlína within the wider community had always been marginal. Salvör, just fourteen years old, guarantees the costs of the funeral and walks back to Marbud, alone.

The second part of the novel charts the rise to prominence of Salvör within Óseyri. She establishes a local branch of the seamen’s union to defend workers against managerial exploitation; educates herself through reading political, evolutionist and philosophical texts; and assumes maternal responsibilities for four children once their mother dies. She is praised for being ‘a match for any man alive’. She is tall, erect and high-shouldered, her thick hair cut short with a side-parting; has courageous clear eyes, strong jaw and full lips, firm hands and a deep voice; and wears Alpine hiking-boots, woollen trousers and a roll-neck Jersey sweater which does not conceal the full curve of her firm breasts. She is commended by her childhood crush Arnaldur (by then a Communist agitator) for being a ‘tovarisch’ (Bolshevik comrade worker) icon, but current observers might recognise her portrait as iconographic of something else. She withstands the pleading entreaties and forcible sexual attentions of now-wealthy but still unscrupulous Steinþor, and leaves Marbud after she discovers it was Steinþor who had provided anonymous funds which enabled her to remain there after the death of Steinunn and Eyjolfur. Once aware of the feckless serial infidelity of the impractically idealistic Arnaldur (and despite some lingering affection for him), she reluctantly but determinedly ends their relationship by encouraging him to pursue his dreams in America. At the end of the novel, when the twenty-two year-old Salvör is finally free of unwanted male attention, the narrator compares her solitary precarious existence to the eggs of winter birds resting on narrow ledges on a high cliff-face: but contemporary readers might contend that having rid herself of both barbarous Steinþor and immature Arnaldur, Salvör may not want but certainly needs to be alone. Though with a typical twist, Laxness suggests she may be pregnant: for as Salvör walks past her most long-standing friend, he comments enigmatically, ‘cold weather to be born in’.

The novel therefore carefully illustrates the potentially damaging consequences of parentlessness, childhood abuse, unexpected bereavement and marital desertion; the corrosive effects of social and economic inequality; and the undermining of the aspirations of women by patriarchal institutions. Sigurlína succumbs after accumulated experiences of deprivation and loss, mediated through demoralisation and despair. It is argued that ‘resilience’ represents a process which allows the resumption of development following trauma or other adversity, and contends that ‘bonding’ and ‘meaning’ are important dynamic features which support this process (5). Those with only fragile affiliation or for whom life has lost its meaning (as depicted by Sigurlína) are less buffered against undermining challenges: but the active community engagement of Salvör provides a supportive network facilitating her eventual passage towards probable independence and emancipation.

 

References 

  1. Guðmundsson H. The Islander. A Biography of Halldór Laxness, trans. by Philip Roughton. MacLehose Press 2008.
  2. Laxness H. Salka Valka, trans. by F.H. Lyon. London: Allen & Unwin, 1973. Originally published in two parts as Þú Vínidur Hreini (1931) and Fuglinn Í Fjörunni (1932).
  3. Magnússon S. The World of Halldór Laxness. World Literature Today 1992; 66: 457-63.
  4. Hallmundsson H. Halldór Laxness and the Sagas of Modern Iceland. The Georgia Review 1995; 49: 39-45.
  5. Cyrulnik B. The Whispering of Ghosts. Trauma and Resilience, trans. by Susan Fairfield. New York: Other Press 2005.

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