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The Internist's Reading: Contextualizing Illness

I had just returned from a week's vacation and had stopped at the local post office to pick up the mail that had accumulated in my absence. The woman behind the counter brought out two large bins and concluded, I'd never go away if I got this much mail. I spent the next 2 hours sorting through stacks of journals, letters from drug companies marked urgent and important update, notices of continuing education opportunities, and requests for donations. The compulsive part of me had to open every piece of mail because in the past, when I didn't, I often threw away important things like airline tickets, phone bills, and tax documents. Screening the maildeciding what to keep and what to throw away, what is useful and what is unimportantcan be exhausting and time-consuming. There is simply not enough time to read everything that comes our way. What does sorting mail have to do with The Internist's Reading? Everything and nothing. Everything, in that the books listed below must compete with all that already vies for our attention. These books demand a significant donation of time; they range in length from 187 to 716 pages. They should be marked, like missives from the drug companies, urgent and important because these books are about what it means to be illfor an individual, for a family, and for a society. Looked at collectively, the themes of these books form the basis for a continuing education course in social medicine. They address substance abuse, alcoholism, homelessness, tuberculosis, schizophrenia, depression, domestic violence, cancer, plague, and the acquired immunodeficiency syndrome. The illnesses portrayed in each of these books are not incidental components of the story line or character development but are focal points of each work. These texts examine illness intensively and form a link between the disease we study as clinicians and the illness lived through by our patients. Like airline tickets and phone bills, these books represent connections to experiences that are at once distant and near (and in the hands of a clever accountant, the purchase of these books is tax deductible). Sorting the mail, on the other hand, has nothing to do with The Internist's Reading in that this list has been selected by me, a practicing internist, for you, my colleagues. Rather than exhaust you, I hope that these books will enrich, enlighten, edify, and entertain. They will not come in the mail, however. They must be sought outborrowed, purchased, or retrieved from boxes of books saved from college humanities coursesand placed alongside medical texts in our professional libraries. Manchild in the Promised Land Claude Brown Published in 1965 This book takes an autobiographical look at Harlem in the 1950s and portrays the effect that illicit drugs, especially heroin, have had on the growth and development of this community. It explores the social and economic conditions that have contributed to the drug problem that now plagues Harlem and other communities. The Plague Albert Camus Published in 1948 An existentialist's view of the way in which an epidemic erases barriers between individuals. Camus explores how individuals confronted by fear and then by certain death react and live the remainder of their lives. Love Medicine Louise Erdrich Published in 1984 A wonderfully insightful and moving story about a young girl growing up on an Indian reservation, torn between two cultures and coping with alcoholism in her family. Ironweed William Kennedy Published in 1983 This is the story of Francis Phelan, a down-and-out drunk roaming the streets of Albany, New York, reflecting on the mistakes of his past. The Magic Mountain Thomas Mann Published in 1924 Mann's timeless masterpiece about tuberculosis, sanatorium life, and the culture of illness. The Second Coming Walker Percy Published in 1980 This novel focuses on a doctor's love for and fascination with a young schizophrenic woman. The novel explores the borders between personality and mental illness and questions the role of drug therapy in the treatment of certain mental illnesses. The Bell Jar Sylvia Plath Published in 1963 A sobering account of a young girl's struggle with depression. Knowing that Plath herself suffered from depression and committed suicide 1 month after the book's publication makes this nearly autobiographical work all the more compelling. A Thousand Acres Jane Smiley Published in 1991 This is a 20th century American version of King Lear with a female protagonist. It is a compelling novel about a repressed woman's journey to self-realization as she confronts her father's abuse and her sister's illness. Cancer Ward Alexander Solzhenitsyn Published in 1969 The full metaphorical meaning of the tumor is explored in this novel, which deals with both Russian history and one individual's struggle with cancer. Illness as Metaphor and AIDS and Its Metaphors Susan Sontag Published in 1978 and 1979 What may be a biological phenomenon to physicians reverberates through society as illness, a social and cultural as well as a medical phenomenon. In the earlier of these works, Sontag explores the metaphors used in literature for tuberculosis and cancer and the influence that these metaphors have had on the popular understanding of these diseases. She notes how these metaphors can create stereotypes, both negative and positive, that can change the way one thinks about those who may have these diseases. The companion work AIDS and Its Metaphors looks at AIDS and the metaphors that have been generated about this epidemic by the scientific community and the lay press.