© 2008 Mahala Yates Stripling

All Rights Reserved

The following is a transcript of the video & audio portion missing from my October 2008, ASBH talk, "Richard Selzer in the 21st Century." --MYS

"BRUTE" (2000 video interview with RS):

Stripling: “Brute” of course is much discussed around the country.

Selzer: Ah. Yes.

Stripling: You sigh.

Selzer: Yes.  Uh.  “Brute.” This of course is based on a true story. A true episode that took place twenty-five  years before I wrote this story.  The brute in it is the doctor, myself. It’s a confession.  Writing it was an act of atonement that I had never forgiven myself for the act that I had committed on this patient when I was stitching his earlobes to the stretcher to make him hold still.

Stripling:  You actually did that?

Selzer:  Yes.  It was a act of brutality and viciousness, which of course  I could never do again.  I was so full of self-loathing and guilt. Twenty-five years later it was still with me, inside of me. I wrote it to exorcise, to exteriorize the guilt from me. I gave it the ambiguous title of “Brute” because in a sense the patient was a brute also of a different kind. That story is often mistakenly seen as racist. It is not! The patient was a black man. That’s just the way it was.  In some schools that is used as a racist story.  That hurts me terribly! It’s a misreading.

*Author's note: In my biography I discuss, at length, how the brutal system in training doctors contributes to their actions. I also ponder Selzer's apology [in "Brute's" penultimate sentence--"How sorry I will always be."], which most readers, who are outraged at Selzer's actions,  miss altogether. I use Aaron Lazare's "On Apology" (Oxford UP, 2004) to shed light, speciifically, on why Selzer's apology doesn't seem to work, and generally, on the nature of apology in the doctor-patient relationship.

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Excerpted portion of Leon Kass 2004 audio interview for Stripling’s 2008 ASBH PowerPoint talk:

I asked Dr. Kass in 2004 if he thought Selzer’s legacy in the medical humanities will be major.

Kass:  Well, I think so.  There are people who can write sort of abstractly and philosophically about the doctor-patient relationship. (I’ve tried my hand at it a few times.) There are people who can write beautifully about the meaning of illness and about death and dying.  But it’s a very rare thing to find someone who is reflective about their own profession, and even rarer to find someone with the kind of gift to show the power of the universal in the particular in a way that is just gripping.  The physician is privileged to see certain aspects of our humanity unguarded, unadulterated.  Most doctors don’t fully appreciate what sort of exquisite encounter they are privileged to have with human beings. And Selzer understands that.

Stripling:  It’s the vulnerability and trust.

Kass:  Vulnerability, trust, courage. In fact, it’s even hard to find exactly the right words for the various things that are there.

Stripling:  He seems to find the words to express all of that in a story.

Kass:  It’s especially remarkable in surgeons.  Surgeons usually go into surgery because they don’t have patience with the longer term approaches in internal medicine. They want to get in there and fix it.  They tend to be technically excellent and humanly under-endowed.  And to find this in a man who lives with a knife and who generally should be a more aggressive and less thoughtful sort, it is especially thrilling.  Think of what it means to have your hands on these organs and to be able to preserve the wonder and awe and respect of that activity, not withstanding having done it hundreds of time. It is really quite special.

=========================

[This publication, out in 2009, contains 3 maps, 20 pages of photographs, and a fan-tree genealogy.]

VOLUME I 

RICHARD SELZER: A LITERARY BIOGRAPHY

Reinventing His Life

             LIFE AND WRITINGS (1928-1984)

====================================================

           Foreword (by Medical Humanities illuminatus)

Preface

Lists of Abbreviations, Maps, and Photographs

Chronology of Events 

Introduction

I.     Trial and Tribulation (1985-90) TWR,IAW

II.    The Carrot of Woe--Yaddo

III.    A Question of Mercy (1991) 

IV.   The Bard of Troy (DFT 1992)

V.      Roosting on the Podia (lectures)

VI.     Raising the Dead  (1993)  Coma crisis

VII.  The Black Swan (1994) “the men wept”

VIII.   The Doctor Stories (1998) book & play

IX.   The Loonies [ministry]; The Exact Location of the Soul (2001)

X. The Whistler’s Room (2004)

XI. Bag of Tricks (teaching at RPI & Yale Med)

XII.  The Illuminati (2005-6)

XIII. The Letters, The Diaries (2007)

XIV.  Knife/Song/Korea (2009)

XV. Legacy: Works in curricula           (bioethics/humanities), lectures,                         teaching, interviews   

          Conclusion 

Endnotes/Works Cited

Acknowledgments

Comprehensive Selzer Bibliography (1968-20--)

Index

           *DVD interview tapes.

====================================================

To read a Dec. 9, 2007 profile with photos on Richard Selzer, go to this link. By Kim Martineau, titled "Surgeon Takes a Scalpel to Words (Hartford Courtant).

http://www.courant.com/news/custom/topnews/hc-selzer.artdec09,0,2119414.story?coll=hc_tab01_layout

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• The "tribute" essay below is referenced in a Sunday, April 15th, 2007, Troy Record article by Kathy Caggianelli.

    We had really no childhood. 

      It was World War II.

--Roseanne Misirian Asadorian

High School and War

A Tribute to the Troy High School Class of 1945

For the last ten years, I have been researching and writing a    biography of one of Troy’s most notable sons – the surgeon and writer Richard Selzer.  Selzer, who will be 79 years old this year, was a prominent surgeon at Yale Medical School before turning seriously to literature at age 57.  He was born in Troy in 1928 – a few years after his parents, driving south from Montreal toward Manhattan, had a breakdown in the city, and decided to stay and make it their home.  His father practiced medicine out of the family home on Fifth Avenue. In the course of learning as much as possible about Selzer’s life and times, I have gotten to know many of his classmates from the extraordinary Troy High School class of 1945.

The experiences of this class coincide with the great conflagration of the 20^th century. The students began their freshman year in September 1941, three months before the attack on Pearl Harbor, and graduated in June 1945—two months before our atomic bombs hit Hiroshima and Nagasaki.  All during their high school years, this class faced a reality no other US class has.

The times were sobering, and every day there was war news to deal with that affected sons, brothers, fathers.  But the city came together in a “popular war” effort, something this nation has not seen since.  High school students learned to identify aircraft and assisted with neighborhood civil defense programs. There were nighttime curfews, and blacking out windows during air raid drills was a regular occurrence that, even without an imminent mainland threat, helped morale. “Many of our fathers (not mothers) were air raid wardens; however, we had the complacency of knowing that the war was ‘over there,’” says Ada Levine Frischer.  (All of the people quoted in this article are graduates of Troy High School, 1945).

           The national crisis of fighting a two-front war meant that times were very lean at home. There was rationing of flour, butter, and meat, and vegetables were only plentiful for those families who kept a backyard Victory Garden (and then only seasonal ones).  Few people could get gasoline, and buying a car was next to impossible.  “No one had an automobile,” John Driscoll recalls. “Those who lived in the center of the city walked to school; the rest of us took public transportation.  As a result, we walked or rode in groups and formed close bonds.” If they went somewhere outside the city, they’d hitchhike. But even shoes were rationed at two pairs a year, except in the case of size changes. Silk and nylon were needed for parachutes and tires, so the popular full-fashioned hosiery with seams was in short supply. The girls adjusted, wearing leg makeup.  They no longer had the hassle of attaching three-quarter length stockings to their upper thighs with a garter belt.  But when they tried to draw the stylish seam lines down the back of their legs with eyebrow pencil, it couldn’t be done over makeup—which is how seams went out of fashion, and seamless nylons later came into vogue.

           Every high school student had a relative or friend in the armed forces, so the June 14^th Flag Day patriotic parade down Fifth Avenue was celebrated in earnest—with Uncle Sam in front, decked out in a red, white, and blue suit and the iconic top hat. (The progenitor of the symbol Uncle Sam, Samuel Wilson, is buried in Troy’s famous Oakwood Cemetery).  Little white flags with red borders appeared in the windows all over the city. A blue star was in the center for each person in the family who was in the service, as well as a gold star denoting one had died; hence, “Gold Star Mother."  The stars and stripes were hung on public buildings, and the schoolchildren waved little flags and sang patriotic songs. Politicians delivered addresses.

           Troy High School, at State and Seventh Avenue (now the Rensselaer County Office Building), had five stories and no elevator, and it was condemned at the time.  But with a sense of expectancy about the economic drain of war running very high, there was no money or supplies to fix it. Many of the Italian and Irish pupils went to the two Catholic high schools in the area, so at Troy High, surnames like Printsky, Jueck, Smeland, and Kazanjian predominated.  For laughs the kids would teach each other words from the languages they heard at home —  Ukrainian, Polish, Yiddish, Armenian. There was also a handful of Black students whose ancestors had come North during Reconstruction or later. Students respected each others’ cultures, and because of the melting pot nature of their student body, most say racism was minimal.

           The curriculum was divided into four specific programs: college entrance, academic, commercial, and industrial arts.  A few courses the college-bound kids were expected to take included French, Latin, Greek, English, American history, civics, chemistry, biology, algebra, and physics.  Because the commercial-course students needed all the available typewriters, many of the others never learned to type—including Richard Selzer, who wrote his many books and stories longhand.  Extracurricular activities were many, such as Gross Club (debate) and Toga Club (honors Latin). Future NBC Vice President Perry Massey starred in Clifford Goldsmith’s “What a Life”—a benefit production for the Red Cross. One of their most successful endeavors, though, was raising an amazing $15,000 in five days through war bond sales.

The teachers also taught the students about life. In their senior year, the invasion of Iwo Jima was announced. John Driscoll had a very serious moment in his English class, under the “fearsome and irascible” John E. Howell, who had a jowly mouth and a tendency to spit when excited. Most days he would keep his spirited class after the bell, saying “Hold on, I have more pearls of wisdom to cast.”  Or he would linger after class and debate with the students. But that day, foregoing the lesson on Shakespeare’s Julius Caesar, Mr. Howell entered the room in an unusually subdued manner and told the class that his son was a Marine officer in the division leading the invasion.  “He spoke to us for half an hour about his family, his son, and the war, and then he got up and left the room.  None of us moved or spoke for the remainder of the period.”

Much more so than today, character development was a part of the curriculum. The teachers cared deeply about the paths students would take and offered encouragement and advice. Miss Buckley, also an English teacher, philosophized:  “Right is right no matter who’s wrong, and wrong is wrong no matter who’s doing it.” The staff and faculty were excellent role models and “the happiness we had in our high school years,” John Snyder believes, “belongs to almost all of them, but especially Principal Doyle, who was a friendly father-figure and very patient.”  One teacher told Rosanne Asadorian not to pin a large white flower in her lustrous dark hair, that it was demeaning (she continued to do so). Some students found faculty advisor Miss Isabel Mann bossy and demanding, but she showed interest in every student, and, even after she retired, sent them Christmas cards with her own design and a poem. Dudley Van Arnam, later superintendent of schools, helped support their many endeavors, as did Miss McTammany, Latin teacher and college-bound advisor. But they were known to be a head-strong class. On occasion the class officers came out with “creative way-out ideas” for campaign tactics and to attract classmates to class functions—including using sex appeal and coffins—and at times the advisors had to rein them in.  

           Even the good kids went “butting” or skipping school. Without malls or the money to spend in them, the students took advantage of the city’s river walks and parks to dream dreams.  Or they’d fool around on the extraordinary Approach that descended from the RPI campus to downtown.  Just a block away from school, the students used the broad white stone steps as their venue for theatrical antics. One afternoon after French class, it  seemed too nice and sunny to stay indoors, so a few of the students acted out an impromptu drama humorously depicting their wartime woes, titled “The Spirit of the United Nations Overcoming the Forces of Evil.” In the photograph below, Dickie Selzer has vanquished his "enemies," namely, his high school sweetheart Janey Landfear and fellow honor students Kitty Cottrell and Helen Ivanyshyn, who are all lying on the steps in a fallen position. “It is hard to explain the joy we felt in each other and in ourselves,” recalls Janey Landfear Caspar. “Golden times.”

“The Spirit of the United Nations Overcoming the Forces of Evil”: Richard Selzer over (L-R) Janey Landfear, Helen Ivanyshyn (plaid dress), and Kitty Cottrell (dark dress with frilly collar). (Photograph courtesy of Jane Caspar)

           During these years, government spending began to turn Troy’s Depression economy into a butter and barrels one. With so many men gone to war, more women than ever worked, toiling in the River Street slaughterhouse to feed the troops, at Cluett, Peabody & Co., to clothe them, or at the Watervliet arsenal to arm them.  A lot of  high school students had jobs before and after school. And with money in their pockets and the economy beginning to pick up, they might go after school to the Puritan, a Greek-run restaurant, for a Coke and a smoke, or to Manory’s ice cream parlor for a sundae. Or they went to the magnificent Troy Theater to see a movie. With the $1.25 he earned per week at his father’s cleaning business, Henry “Babe” Tutunjian, who later became a respected judge, could scrape together a nickel to attend a double feature with Dickie Selzer, who delivered prescriptions.

         Feverishly patriotic, many young men lied about their age or were drafted into the war effort. So for the benefit of the classmates who might not be with them after January, the prom was held in November.  The boys anxiously looked over their meager funds before asking dates and getting corsages. Girls and their mothers selected material and sewed formal dresses, hunting for just the right shoes and accessories. The prom committee selected music for close dancing from the big bands, like Glenn Miller's "Moonlight Serenade" and Harry James’ "You Made Me Love You." They danced to the fox trot and jitterbug.  But the event also had a tendency to cause heartbreak:  a boyfriend might be shipping out to the Pacific, or a girl might feel her patriotic duty was to spend time with a solider rather than her regular boyfriend.

           There is a noticeable lack of young men in the formal graduation picture taken on The Approach. That ominous-looking day, no one there knew the war would end, soon and dramatically, bringing many of the hometown boys back. The “Class Song of ’45,” composed by student Carolyn Eycleshimer in the unusual key of A flat, ended: “Troy High, we shall not forget thee, though our paths lie far apart. As we strive for mankind’s liberty, we shall praise thee from each heart.” Class treasurer Dickie Selzer had diligently collected two payments of 25 cents from each student to publish the yearbook, The Dardanian (a name derived from Shakespeare’s The Merchant of Venice). But it almost didn’t happen because of the wartime paper and photographic equipment shortage. The book is dedicated, respectfully, “to the classmates who are serving in the Armed Forces of Our Country,”

           Bound together by war and deprivation, the ‘45ers remain a tight-knit group. Just the flourishing nicknames they had for each other tells an affectionate tale: DoDo, Sparkle, Heinz 57, Bashful, Carrots, and Itch (for the girl who couldn’t sit still). Sixty years later class president John Snyder reflected on why his classmates continue to have good relationships and concern for one another.  “This bonding was carved out from going through the war years together and even growing up during the depression before that.  We were very aware of the opportunities we were receiving and how much it would mean to our future lives as adults to continue on to college or to start out with a career. A lot of the feelings we had for each other came from the atmosphere at school, which developed a positive attitude in young people from the ages of 14-18. I just didn’t want to miss out on anything going on at school—and was rarely absent—and other classmates felt the same.” 

           Marion Wansovich Tashjian of Troy, who readily provided me with class statistics, epitomizes the self-reliant and caring nature of the ’45ers: “everybody knew and helped each other.” Betty Uline Engineri, who initially kept the class list, was the driving force in helping plan the 25th reunion in 1970.  After Betty moved out of state, Marion became keeper of the list, helping to plan the 45th reunion in 1990, as part of a reunion committee that meets for bi-monthly luncheons.  The next reunion, the 65th, will be in 2010. The class of 196 produced a lot of high achievers (many men took advantage of the GI Bill after the war). They became administrators, engineers, teachers, doctors, lawyers, judges, and a network executive. But, most importantly, they are patriotic and hardworking with families to be proud of. Betty Vaughn Cipperly uses an expression of the times to explain it: “You are who you are because of where you were when.”

           Of the remaining 123 '45ers, I came to know more than a dozen while interviewing them for the biography I’m writing on their classmate, Dick Selzer. What struck me the most, over this ten year period, was how unfailingly reliable, genuine, and eager to help they all have been. They expressed a great affection for each other, even though it’s been over sixty years since they walked the halls of Troy High together. They told me it was both fun and painful to revisit the past, forged out of the best and the worst of times (to borrow from Dickens). Getting to know the ‘45ers has been one of the most significant experiences of my life. As a baby boomer, I realize how directly I have benefited from the sacrifices they and their generation made during World War II, and I agree wholeheartedly with Tom Brokaw in dubbing my new friends “the Greatest Generation.”

           And so, I pay tribute to the Troy High School Class of 1945, "still making news after all this time" (Marion Wansovich Tashjian).

           Respectfully, Mahala Yates Stripling

 Author’s Note (September 8, 2007): I excerpted this article, in part, from my forthcoming biography of Richard Selzer.  Besides those ‘45ers mentioned above, I also interviewed or received letters from Dick Phillips, Walter Speidel, Elsie Landau Finkelstein, Mel Wulf, Alberta Braveman Subkowsky, Anna Mae Tashjian Mourachian, Estelle Siegel Reisner, and Helen Califano Belanger. Contact Dr. Stripling at DrRhetoric@aol.com.

Photographs to be posted:

1. Honor Students The Times Record, Troy, NY) 1945

2. THS Donates to Red Cross (The Times Record, Troy, NY) 1944

====================================

Book by Dr. Stripling

Customer Reviews Average Customer Reviews:   Wonderful step by step guide through these changing times, February 28, 2006   Reviewer: Melanie Cox - See all my reviews    I read a great deal of literature while sitting vigil at a hospice. Dr. Stripling takes you through our changing times and leads us to wonderful reference material.  She very gently takes us on a nonjudgmental journey and helps us to see our own truths and limitations as we strive to help this world be a more giving and and caring place. I would hope to see this book in every high school and college library and hospice in our country. This resource for high school teachers and librarians describes ten accessible works of fiction that may be used to help students explore a number of contemporary issues in medicine and bioethics. The selections analyzed span two centuries, from Mary Shelley's romantic novel Frankenstein (1818) to Margaret Edson's play, Wit (1999). Supplemental materials include a glossary, a list of recommended movies, and a chronology of key events in literature, medicine, and science.”–SciTech Book News Science, ethics and literature mesh well, February 4, 2006 Reviewer: Linda Lucas "Library Junkie" (Ft. Worth, Texas) - See all my reviews    This book is a fascinating combination of science and science fiction. The reader is transported to the past through Shelley's "Frankenstein" and into the future with Huxley's "Brave New World" and Cook's "Coma." We read of the true ethical dilemma of Feldshuh's "Miss Evers' Boys" and the disturbing issues of experimentation with human cloning, stem cell research, and bioterrorism. Dr. Stripling leads the reader through a maze of fiction and truth. She ties it all together, with an occasional touch of humor, in a narrative that is easy and interesting to read. This book should be in high school classrooms and in medical school curricula. I thoroughly enjoyed the ethical and medical issues linked with literature. Topics for oral or written discussion accompany synopses of plots, July 6, 2005   Reviewer: Midwest Book Review (Oregon, WI USA) - Advances in science have brought with them their own unique ethical and medical dilemmas, bringing the discipline of philosophy directly into the world of science. Students from high school to pre-med receive a well-rounded introduction to literary references to bioethical questions, from the beings created by technology to illness and end of life issues. Topics for oral or written discussion accompany synopses of plots. Reviewer: School Library Journal This series promotes a multidisciplinary and multicultural approach to teaching literature across the curriculum. Each title includes a chronology of events related to the literature and the social issues), an introduction, discussions about the works with plot synopses, literary analyses, historical context, further-reading suggestions, lists of topics for written and oral discussion, and recommended movies and Web sites. Worthwhile addition for schools with an integrated curriculum.–Pat Bender, The Shipley School, Bryn Mawr, PA   Loved it!!, May 29, 2005   Reviewer: Nancy B. Parker -   This book is so 'present tense.' Mahala Stripling is delving into questions that all of us must face. I love the timeline; it gives me perspective outside of the contents of the book, as well as within. The author has tied together literary criticism, literature, and unavoidable 21st century decisions within the pages of her book.

 BIOETHICS AND MEDICAL ISSUES IN LITERATURE 

GREENWOOD PRESS, 2005

Table of Contents

Foreword                                                                                              Preface

Chronology of Events in Literature, Medicine, & Science       Introduction

Chapter 1. Technology's Creature                             Historical Context, Literary Analysis, and Plot Synopsis of      Shelley's Frankenstein & Hawthorne's "Rappaccini's Daughter"

Chapter 2. A Brave New World                                        : Historical Context, Literary Analysis, and Plot Synopsis of     Huxley's Brave New World & Cook's Coma

Chapter 3. Contagions/Isolations                                            Historical Context, Literary Analysis, and Plot Synopsis of      Camus' The Plague & Feldshuh's Miss Evers' Boys

Chapter 4. Illness and Culture                                        : Historical Context, Literary Analysis, and Plot Synopsis of     Kesey's One Flew Over the Cuckoo's Nest & Walker's Possessing    the Secret of Joy

Chapter 5. End of Life--Disease and Death                  Historical Context, Literary Analysis, and Plot Synopsis of     Updike's Rabbit at Rest & Edson's Wit.

Glossary of Terms: Literary, Medical, and Scientific              

       Afterword                                                                                    

Appendix A: Recommended Movies                               

Appendix B: Recommended Internet Sites                          

Appendix C: Recommended Books and                      

Appendix D: Recommended Methods for Teaching                           

Index

 To order: http://greenwood.com

or; http://amazon.com

Book Code: GR2040
ISBN: 0-313-32040-3

April 30, 2005

NOTE: For use by teachers of interdisciplinary studies, from high school to post-graduate medical school.

 Preface

            Bioethics and Medical Issues in Literature has multiple uses.  First, it is part of the Exploring Social Issues through Literature series developed to meet the needs of secondary school students and their teachers who will delve into social issues identified in a range of accessible literature.  When used in the language arts curriculum, the book intersects social studies issues and literature. Furthermore, educators in the arts and humanities and sciences can benefit from examining social issues in the intersection of literature and science. Along with the clear interdisciplinary benefit for students, the material fosters communication skills by building vocabulary because literary, scientific, and medical terms are clearly defined, giving easy access to the nonspecialist. The provocative topics also inspire writing while offering the opportunity to study both the technical and human side of medicine.  Through investigating medical topics situated in literature, the book informs, develops thinking skills, and challenges students who may feel encouraged to pursue higher education in science, medicine, and the humanities. Second, high school librarians will find this book a valuable reference for units in English or literature, history, science, and the social sciences.  

            Third, students from high school through pre-med and other college students will find that topics in this book engage them in ethical debate, informed decision making, and career exploration.  In addition, the topics teach important interdisciplinary lessons such as respect for diversity and the art of medicine. In fact, the depth of material presented here makes this book ideally suited for any one in or entering a health care profession since the stories included serve as ethical guides. They also address the socio-cultural as well as psychological and physical dimensions of medical practices, showing how humanistic attitudes combine with scientific facts to represent different aspects of healing. For these reasons, it is not surprising that courses in interdisciplinary literature and medicine are flourishing at all levels from high school and college to medical school and throughout post-graduate training, as educators see the need of enhancing a science or medical education with the humanities.  Bioethics and Medical Issues in Literature develops the desired critical and empathic thinking skills with its references all the way back to ancient medicine and selections that span a two hundred year period since the birth of modern medicine in the early nineteenth century to the present.  Therefore, and last, public and academic librarians can recommend this book to the general reader to be read alone or to serve as a companion to the referenced literature written by insightful authors who blend literary and medical ideals into interesting and lively reading. It offers an amazing journey.

            Besides drawing facts from the major disciplines of medicine and science, this book considers ethical and humanist issues by frequently citing two other significant bodies of knowledge, bioethics, a discipline founded in the late 1960s, and literature and medicine, an interdisciplinary field of study established in the mid-1970s. It develops topics such as the Human Genome Project, stem cell research, Frankenscience, cloning, gene therapy, eugenics, utopias, organ transplantation, contagious and chronic diseases, doctor-assisted suicide, and public health issues such as sexually-transmitted diseases and bioterrorism.  The obesity epidemic, mental illness (diagnosis and therapies), cultural rituals, clinical studies, longevity and aging, and compassion in end-of-life care, dying and death are also addressed. Our rapidly changing technology has introduced many ethical controversies, making the medical field—both its education and practice—increasingly complex. Therefore, this book spotlights concerns such as the importance of communication in the doctor-patient relationship and the pertinence of issues relating to how we should now define death. It identifies the resources we will need to draw on in our brave new world of stem cell research to solve problems. Contemporary bioethicists even ask, What does it mean to be human?  What science cannot explain, literature explores.  

            Some of the works chosen, like Shelley’s Frankenstein and Huxley’s Brave New World, are familiar, regularly assigned classics because their important themes relate to contemporary issues. Medical topics are situated in these stories with references to hard science texts, with the common thread being we have much to learn from the past. Most of the titles have been translated to the big screen, showing how they have captured our imagination. The ten classical and contemporary works of fiction—seven novels, two plays, and a short story— selected for their relevance to twenty-first-century medical news stories ripped right from  the headlines, are contained in chapters with these thematic titles:  "Technology’s Creature," "A Brave New World," "Contagions/Isolations," "Illness and Culture," and "End of Life—Disease and Death." The "Historical Context" section for each work contains a short author biography and defines the medical issues and humanities topics, giving an overview of their development in time. An in-depth evaluation of the issues set within the literature follows in the "Literary Analysis" section.         

            Each of the two sections in five chapters can be read alone.  In addition, their arrangement is chronological so that each successive work builds on concepts that precede it.  For example, Shelley’s Frankenstein, although written 200 years ago, sheds light on Cook’s Coma and late-twentieth-century organ transplantation by emphasizing scientific hubris and the need to monitor research. Camus’ The Plague reflects on Walker’s Possessing the Secret of Joy by showing how the media can be both charlatan and savior when alerting the public to medical dangers.  Updike’s Rabbit at Rest and Edson’s Wit look, respectively, at heart disease and cancer diseases that continue to plague humankind. Hawthorne’s “Rappaccini’s Daughter” and Feldshuh’s Miss Evers’ Boys reveal the dire consequences of medical discoveries both unconscionably applied and withheld.  Huxley’s canonical work Brave New World and Kesey’s popular Cuckoo’s Nest demonstrate that many mysteries of the human psyche are still left to solve.  These are just a few of the ways to compare and to contrast the various issues in each section, which also contains a plot synopsis. The book includes a helpful historical overview, "Chronology of Events in Literature, Medicine, and Science," and at the end quick-reference definitions appear in "Glossary of Terms: Literary, Medical, and Scientific."  In addition, with the belief that every text should offer an opportunity to build vocabulary skills, whether it be for personal use or for academic testing, potentially unfamiliar words are glossed at the end as well. Four appendices list additional resources and references, such as recommended movies, Internet sites, journals and books, and specific ideas for teaching.

            At the end of each section students respond to the topics posed for oral and written discussion as further contemplation builds the all-important critical thinking skills. For instance, noting that we live in a global community, students might argue the different sides of the main issue in Walker’s Possessing the Secret of Joy:  Should a First World country interfere with the culturally entrenched morality of a Third World African female ritual? Or, as featured in Camus’ The Plague, they can scrutinize the ongoing role the media play both to educate and to sensationalize contemporary medical issues such as HIV and the Ebola virus, creating both informed and fearful citizens. By exploring sensitive distinctions, students develop a national social and international cultural perspective. These provocative issues lead to animated class discussions that create camaraderie among students with diverse backgrounds, interests, and career goals. By responding in writing to the questions, students usually delve deeper into their emotions.  There is broad student interest in this book’s central interdisciplinary concept that as science forges ahead, we will need the humanities to put the human face on medicine.  By actively encountering bioethics and medical issues situated in stories, students make the significant connection that literature reflects the social issues incumbent in our world culture. Then they can apply this knowledge, combined with their own meaningful experiences and a mindful life, to form values and to make reasoned deliberations on ethical issues in our increasingly complex and interesting world.

          This book adds to the growing body of literature that identifies and addresses mounting twenty-first-century concerns by grounding students in an interdisciplinary program. Stories reveal the human condition, which after all is the subject of scientific endeavors.  These 10 works declaratively answer the question, What is the role of the humanities in bioethics? Besides, adding humanities and social studies to science makes for lively discussions. As I respond thusly to these issues, I note that from Harvard University on down education reform is embracing a “skills across the curriculum” approach, arguing that all students are as capable of learning science as they are of mastering subjects in the humanities and social sciences. Educating our citizenry to make informed decisions with a dual facility is imperative as we face ongoing bioethical and medical challenges in our brave new world.

       At last, it is my intention that the contents of Bioethics and Medical Issues in Literature will encourage teachers and their students as well as other readers to conduct further research, resulting in critical thinking. Socrates said, "The unexamined life is not worth living," and it will be my pleasure to guide you toward a fuller understanding of the many new issues presented in the twenty-first century. 

            There are many people to thank who helped me over the three-year researching and writing period to complete Bioethics and Medical Issues in Literature. Although an author’s life is necessarily one of aloneness, I have not been intellectually isolated.  Besides keeping company with the great thinkers whose ideas have contributed to this book, I have relied on numerous people and resources to authenticate my views. I want to thank my editors, Claudia Durst Johnson and Lynn Malloy, for their knowledge and support in helping me conceptualize the book and bring it to fruition. I appreciate Harris Methodist Fort Worth Hospital Director of Ethics David Isch for giving me an overview of hospital procedures, policies, and ethics. In educating myself about the role of institutional review boards in overseeing clinical research, I have benefited from communicating with the University of Texas Southwestern Medical Center Institutional Review Board Administrator Pat Fisher.  Also from Southwestern, medical student and Doris Duke Fellow Louise P. King, J.D., described her medical school routine and experiences.  Neuroradiologist Dr. Michael O. Harding was helpful in general medical discussions.  I am further indebted to the University of North Texas Health Science Center Medical Humanities Director Sue Lurie, Ph.D., for comments on specific text and for helpful insights on related curriculum issues.  A special thanks goes to the unsung heroes of literary achievement, the Fort Worth Public Library interlibrary loan researchers who in a timely fashion got for me an eclectic assortment of scores of books and articles from all over the country.  I appreciate Linda Lucas’ diligence and keen eye while reading my manuscript and commenting on its ability to reveal important social issues in pertinent literature.  I am grateful to Beverly Robertson, R.N., for her insights on the human condition—the wonderful bodies we possess—especially our hearts and minds.  In addition, as I worked on Bioethics and Medical Issues in Literature I tapped into the vast knowledge accruing from 10 years of research and interviews with medical luminaries who contributed to my forthcoming biography on Yale surgeon-writer Richard Selzer.  He bears the responsibility for inspiring my medical humanities pursuits. Finally, I owe a very special debt of gratitude to my husband, James L. Stripling, for his continuing support, love and encouragement, and meticulous editing. I could not have written this book without him.

    Introduction

 Bioethics and Medical Issues in Literature, in the Exploring Social Issues through Literature series, defines specific bioethical and medical issues, gives an overview of their development, and analyzes them in literature.  In addition, it relates current perspectives on these issues and cites specific ongoing concerns.  The 10 works of fiction analyzed in this book for their relevance to contemporary social issues succeed because their authors placed characters in situations beyond the realm of what was known.  That is, what science had not yet broached, their writings explored. The selections spanning 200 years from Mary Shelley’s romantic British novel Frankenstein in the Industrial Revolution to Margaret Edson’s Modern American play Wit in today’s Biotechnical Revolution, show that as much as things seem to change, the same fears expressed long ago persist.  In particular, the question concerning the advancement of science taking precedence over individual human rights looms large. The authors have used creative license in their fiction to explore this important social issue as well as others that continue to form and test us.  As the chain of events since the age of modern medicine shows, we have much to learn from the past, which literature encapsulates. 

            In five thematic chapters, bioethics and medical issues revealing the human character and condition are set into ten fictional works.  In chapter 1, “Technology’s Creature,” the two works, Mary Shelley’s Frankenstein and Nathaniel Hawthorne’s “Rappaccini’s Daughter,” have been warning us for a long time about scientific hubris and unmonitored research.  In Frankenstein a stealthy young scientist invents life and unleashes a monster; in “Rappaccini's Daughter” an unconscionable father turns his innocent daughter into an experiment. While Shelley’s nineteenth-century lifetime highlights other specific issues such as women’s rights and healthcare concerns as documented in incidents of puerperal fever, currently Frankenstein is being invoked as a cautionary tale.  Like Victor Frankenstein, are stem cell scientists playing God in trying to create and to alter life, with the outcome unknown?  Or, are these fears unfounded, outweighed by the potential benefit to mankind?  Hawthorne’s work further elaborates on the scientific mind—in particular, rivalry and abuse of the Hippocratic tenet, “First, to do no harm”— two concerns applicable in today’s race to achieve. 

            As the United States entered the brave new world of stem cell research and cloning, in 2002 President George W. Bush appointed an 18-member Council on Bioethics. It is made up of medical doctors, lawyers, philosophers, theologians, biomedical and social scientists, policy experts, and medical ethicists to advise him on ethical issues arising from biomedical and technological advances in science. The council’s reports also influence the U.S. Congress, future legislation, and government funding. Called “the conscience of the country,” the council has deliberated on many issues, but on April 1, 2004, it released its long-anticipated recommendations on stem cell research, with the majority voting for a ban on cloning-to-produce children and a four-year moratorium on cloning-for-biomedical-research.  It would not outlaw human embryonic stem cell research altogether, saying it needs time to review current practices.  In federally funded research the council calls for more self-regulation and a ban on “outlying experimental practices.”  Trying to reach a compromise, President George W. Bush approved of therapeutic stem cell research on existing embryos up to 14 days maturity discarded from in vitro fertilization clinics, which are in short supply and contamination may limit their use. He also reaffirmed his moratorium, following the lead of the council, on spending federal funds to create new embryos for reproductive human cloning research or that which might result in the development of a full-term baby.

            The report is troubling to many anti-abortion groups, tying into the fundamental debate on determining when life begins. Conversely, the report is heralded by those who are looking for cures. Researchers grow from stem cells replacement muscle and nerve tissues that could be used in a damaged heart or as remedies in specific diseases like cystic fibrosis.  The council, furthermore, has asked for a temporary moratorium on research into creating hybrid embryos using human egg and animal sperm and vice versa and gestating human embryos in animal bodies.  It ponders the ethics of buying, selling or patenting human embryos, which is of viable commercial interest. Concerns linger about the kind of creatures technology can create, and the council wishes to discourage rogue researchers intent on cloning embryos grown specifically for harvesting human parts or into a full-term human baby.   

            The President’s Council on Bioethics will continue to debate these and other issues, including, Is research cloning in humans morally justifiable in principle? Maintaining human dignity—asking what does it mean to be human— is a chief concern.   Nonetheless, two weeks before the council’s report, what was once theoretical was taken into the realm of reality on February 11, 2004, when South Korean scientists announced they had cloned human embryos.  Using the same somatic cell nuclear transfer technology applied to the 1997 cloning of Dolly the sheep in Scotland, they produced human embryos solely for the purpose of harvesting the all-important therapeutic stems cells.  Clearly the genie has left the bottle—the age of cloning has begun—with this achievement demonstrating that science cannot be stopped. Nonetheless, it raises the specter of  Frankenscience, a scientific creation that has the potential to destroy its creator.  The clear and present danger is that technological achievement is running well ahead of public policy, reinvigorating political, religious, and ethical debates. While some U.S. states proceed without government funds and approval, and other countries are on a swift march into scientific discoveries, the 2005 U.S. federal budget—reflecting drains from wartime, national health-care costs, and worldwide disease and disaster relief—continues to limit funds for scientific research and education.  In summary, a few issues chapter 1 highlights are: problems with the stealth of scientific research; the fear of technology, especially the unknown outcome of scientists playing God and of developing technology’s creature; and the inherent problem in seeking perfection and in attempts to develop a utopia (Who decides?).  

            It is not a great leap into chapter 2, “A Brave New World,” to discuss Huxley’s description of dispassionate eugenics in Brave New World and Cook’s imagined commercial avarice in the human transplant industry in Coma. The former predates the horrors documented in the 1940s U.S. sterilization movement and subsequently in the Nazi war experiments. The latter predicts the continuing shortage of human transplant organs and problems with assignment, imagining a horrific solution.  In both novels individuality is sacrificed for the greater good. In Brave New World —in order to restore order after anthrax attacks— the government controls and conditions its people, who lack free will.  It shows the inevitable harm from genetically determining a society and psychologically conforming it with pharmaceuticals from birth through the end of life. The 1932 novel sheds light on our twenty-first century brave new world of genetic engineering and cloning, underscoring the technical ability to create and to manipulate human life that runs well ahead of public policy.  Science has the ability to alter human DNA, for better or worse. Now, along with the reality of these new and exciting biotechnologies that prevent and cure disease may come ethical problems.  In a Huxleyan manner, will high-tech eugenics promote caste-like discrimination and undermine equality?

Similarly, Cook’s gruesome theme of harvesting organs from unwilling donors, as depicted in his medical thriller Coma, is not only possible but even probable, he says.  He spotlights research advanced in secret and the dangerous mixture of drug-addicted doctors and dehumanized patients leading to medical mistakes.  The legal procurement and fair dissemination of human organs in the transplant industry, as well as the definition of brain death, are central issues in Coma. The thriving international black market brokering the organs of the poor to save the lives of the rich is addressed in Michael Finkel’s article “Complications.” Chapter 2 also discusses the many myths and inadequate procedures that inhibit the transplant process, and the informed consent guidelines governing it. Every year 85,000 anxious Americans wait for lifesaving organs, and 6,000 die before they arrive.  The National Organ Transplant Act bans the purchase or sale of human organs because, understandably, only the rich would benefit.  Some states offer living donor tax deductions to offset expenses; other states are proposing laws to reimburse the expenses of living donors and of the families of deceased donors.  In recent times xenotransplantation, the use of animal tissues and organs in humans, is a commonplace alternative, but rejection and cross-species infection are factors.  The technology is here for growing body parts, such as kidneys and corneas, for transplantation. But will they be available to everyone in need?   In this brave new world, biotechnology promises to reshape nature as we know it.  And, indeed, recombinant gene therapies can even alter human DNA. Anthropologists ponder how benefits accruing from reproductive innovations will compare to natural selection? The widespread fear of the unknown, as magnified in Michael Crichton’s 1990 depiction of chaos theory in Jurassic Park, should accelerate public debate.  

            In chapter 3, “Contagions/Isolations,” Albert Camus’ The Plague reveals a plague-stricken community’s dynamics, especially after a self-sacrificing doctor must deal with medical issues isolated from the rest of the world. In the unrelenting nature of plague his medical ethics are challenged, provoking philosophical discussions about man’s morality in an atmosphere of every-man-for-himself.  It also defines true heroism, a term assigned freely today.  The Plague highlights political, social, economic, and religious issues that arise from a medical emergency, offering an ideal segue into the next section, David Feldshuh’s Miss Evers’ Boys, which describes a baseline syphilis study initiated before effective treatments were available.   Richard A. Shweder in “Tuskegee Re-Examined” holds a contemporary view that hindsight moralizing will not heal wounds and recalls that paternalism—the withholding of information from patients—was a standard of care for blacks and whites in the 1930s.  The Public Health Service medical professionals should not be characterized as racist evildoers, he says, especially because the 1950s standard of care including penicillin had not proved effective in a late-term syphilitic’s quality of life or morbidity.   The idea of the prejudicial application of medical treatments is extended into the reality of Nazi war experiments and into our international age of AIDS. Both the Nazi war crimes resulting in the Nuremberg Code and the Tuskegee Syphilis Study influencing the Belmont Report shed light on human subject research protocols, including informed consent, evolving into the creation of institutional review boards (IRBs).  With the new age ushering in dazzling possibilities such as pharmaceuticals and gene therapies that alter who the person is, IRB watchdogs must continually ask whether research contributes to the general good more than it devalues individual human life.

            The focus of chapter 3 is to show that “plague”—all infectious disease—which antedates humans, continues to determine the course of history and is never gone for good. The solid evidence of this appears in daily headlines warning of recent global outbreaks of polio, influenza, tuberculosis, the newly discovered SARS, and the yet to be known. Only now are the worldwide ramifications of AIDS—first identified in the 1970s— being felt.  Medications commonly administered in the United States are not cost-effective in other countries, creating an upsurge in orphans, an abhorrence stressed during World AIDS Day.  Otherwise, critics say the media’s focusing attention on sporadic incidents of mad cow disease takes the emphasis off of the biggest food-borne risks from salmonella, E. coli, and other bacteria killing thousands ever year. While it behooves everyone to be informed healthcare consumers, the downside to media overexposure is seen in the current population of “worried well” neurotics who self-diagnose, always expectant of the next emerging disease.  Fearful overreaction to sensationalized reportage and commercial drug advertising tax doctors and other therapeutic resources. The Plague, in which the media falsely report and withhold information as well as advertise false cures, and Miss Evers Boys, in which a 1972 whistleblower ended the study, both raise questions about the increasingly symbiotic relationship between the media and medicine in the twenty-first century. The American public looks to medical news reports on television and in newspapers.  It devours medical thriller novels and absorbs often sensationalized plotlines in fictionalized television shows. In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta and other governmental agencies rely on their collaboration with the media to report legitimate stories as well as to advance agendas.

            In summary, the key to controlling infectious disease outbreaks is early detection, establishment of vaccine protocols, and public education. Hygiene and quarantine may be the first line of defense in containing infectious diseases.  Moreover, understanding how they originate and generate, as in insect-animal-human transference, is crucial.  No matter what firewalls are put up, however, the truth espoused in chapter 3 is that infectious disease recorded since the earliest historical accounts has proved indomitable. Epidemiologists continually try to keep up with the next generation of diseases.  They maintain a hypervigilance on known pathogens coming out of hiding somewhere in the world after lying dormant for decades and on those recombining into super bugs.

            The main theme in chapter 4, “Illness and Culture,” is that illness is often culture-specific and that diagnostic methods and treatment options change over the years.  America’s path has been long and arduous since the early days when the mentally ill and retarded roamed the streets. There are now many different approaches to diagnosing and treating the mentally ill, such as using brain scans and DNA analysis as well as using psychotherapy and drugs. Ironically, many who should seek help (schizophrenics, for instance) find themselves homeless and untreated since the National Institute of Mental Health, created in 1946, activated human rights laws including privacy and autonomy. The two works in this chapter, Ken Kesey’s One Flew Over the Cuckoo’s Nest and Alice Walker’s Possessing the Secret of Joy, continue to influence twenty-first-century medical issues and ethics by describing the cultural origins of mental illness.  In 1962 Kesey horrified readers with his graphic depictions of electroshock treatments and lobotomy, causing the mental health industry to rethink its approaches.  These so-called barbaric methods are back into use for treating depression when drugs and psychotherapy are ineffective.  

            Nonetheless, the new age of pharmaceuticals provides a variety of magic bullet cures. Some drugs, along with effectively treating symptoms, may change the recipient’s personality though. For instance, a new therapeutic forgetting drug is in clinical trials. It has the potential to eliminate disabling emotions such as fear and guilt in soldiers or rape victims.  Opponents argue that blocking post traumatic stress disorders (PTSDs) reduces capacity for empathy, reshaping who that person is—as in soma administered in Huxley’s Brave New World.  Proponents believe the drug by eliminating a person’s crippling emotions restores quality of life (Henig, “The Quest to Forget”). Should the Federal Drug Administration (FDA) approve the drug after more extensive study, bioethicists will have to determine whether the drug’s benefits outweigh the side effects and risks, especially in the 70 percent of PTSD patients who eventually recover anyway.  In the nineteenth century Ralph Waldo Emerson expressed his belief that there is innate value in all experience, whether positive or negative, because it defines who we are and how we interact in the world. 

            In Possessing the Secret of Joy Walker illustrates how our views on normalcy depend on the culture and time in which we live in.  Actions deemed criminally insane and unethical in one area of the world are culturally entrenched in another.  The World Health Organization estimates that 100 million women worldwide have undergone female genital mutilation (FGM), a difficult issue to explore.  The African culture Walker depicts has socially constructed a practice with detrimental mental and physical health consequences, linking health, education, and human rights.  Possessing the Secret of Joy describes women subjugated to fundamentalist beliefs and denied equal protection under the law, even though the Universal Declaration of Human Rights states human rights are inalienable: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment” (United Nations General Assembly Resolution, 1948).  Changing ritualistic behavior takes several generations, however, a fact understood by an Italian surgeon who offered to “safely” perform the rite, preventing the germ-laden hut-butchering of girls. He caused an international outrage. Showing that education is the key, 200 FGM practitioners attended the 2004 International Women’s Day in Kenya, announced they had abandoned the practice, and vowed to fight it. Although the 2002 Children’s Act outlaws the practice, in northeastern Kenya 98 percent of the girls between five and nine undergo radical FGM.  Local magistrates levy light punishment, if any, for violations.  Kesey and Walker illustrate the long-term detrimental consequences of socially constructed practices. The historical perspectives in chapter 4 build worldwide awareness on the value of education.

            At last, the intent of chapter 5, “End of Life—Disease and Death,” is to demonstrate, in the words of Thomas Mann, that “all interest in disease and death is only another expression of interest in life” (The Magic Mountain, 495).   Two radically different protagonists give views of heart disease and ovarian cancer, respectively, in John Updike’s Rabbit at Rest and Margaret Edson’s Wit.  In the former, Rabbit Angstrom, who is filled with male angst, does not engender sympathy; however, in the latter, Dr. Vivian Bearing, who is subjected to technology and the inhumanity of research protocols, experiences a nurse’s kindness. Other topics developed in Rabbit at Rest include the obesity epidemic and the popularity of gastric bypass operations; the Me Generation and family values, and cocaine addiction and therapy. Immense strides have been made against heart disease, including gene therapy, transplants, and even cloned replacement parts. New early screening techniques are changing prognoses.  Less efficient, it seems, are efforts to educate the general public about preventive measures, including maintaining the ideal weight and blood pressure, and lessening stress.  Gastric bypass operations, while often effective, include risks from wound infections to death. In 2004 the U.S. Surgeon General declared obesity an epidemic and second to smoking as the leading cause of preventable death.  At the same time, in the United States 13 million children go to bed hungry most nights.

            In the engaging play Wit, Edson looks at cancer, research, and ethics. Once considered the silent killer because of its often late detection, ovarian cancer, the subject of Wit, now has more clearly defined symptoms making earlier detection and treatment possible.  In fact, many other types of cancer, once a death sentence, often may be cured if detected early.  Or, rather than using toxic drugs, cancer may be left uncured and treated like a chronic illness with surgery and a new generation of drugs.  In 2003 the National Cancer Institute reported cancer killed 556,000 people; in 2004 8.9 million people were living with it.  The drive to find a cure fuels scientific research.  Breakthroughs include shutting off the blood supply to tumors, cancer vaccines, and new-age cocktails or combination drugs.  With heightened screening and gene diagnosis, new drugs even tackle precancerous phases. Wit also addresses psychic and physical pain.  With greater understanding of their similarities and differences come new therapies.   For instance, brain imaging techniques reveal a cross-talk between the two, leading to new approaches including anxiety medications.

            In an analysis of Wit, the duties and responsibilities of medical professionals are scrutinized as they interact with Dr. Bearing during the last phase of her life as a research volunteer.  Human research ethics evolved from twentieth-century concerns over yellow fever treatments, having deep ethical roots in Hippocrates’ tenet “First, to do no harm.”  The system for protecting human research participants improved following the World War II Nazi experiments on Jews, set out in an international guide called the Nuremberg Code of Ethics.  Later, the effects of the experimental drug thalidomide administered to pregnant women, which caused severe birth defects, led to a better formulation of informed consent in clinical trials. A primary concern of the research community, which polices itself, is to maintain the human dignity of research volunteers.  Good science and good ethics should go hand in hand.   Outrage at the Tuskegee Syphilis Study prompted the National Research Act of l974, which in turn established local-level IRBs and the National Commission for the Study of Human Research.  The important moral and social responsibility integral to human research is summarized in the Belmont Report, which sets out the basic principles for research ethics:  respect for persons, beneficence, and justice.  In addition, Wit highlights intangible qualities such as kindness and hope as they relate to patient care and quality of life.

            The 10 works in Bioethics and Medical Issues in Literature, ranging in scope from a classical novel to a contemporary play, teach lessons in a wide range of medical and social issues.  They cast a light on rapidly advancing technology, the need for public education, and the urgency of health-care reform. Science education now includes not only education in science and technology but also in social responsibility, often taught with literature.  As new science and dazzling technology continue to contribute to Western medicine, literature reminds us of the human condition.  Uncovering the pathophysiology of disease and solving the puzzle of its progression go hand in hand with acquiring the moral ability to apply this knowledge to sick and suffering humans.

         Twenty-first-century medicine promises many great things in nanotechnology, imaging techniques that reduce the need for invasive surgery, and gene analysis and therapy. Again, humans are the basis of these enterprises. At last, the primary lesson taught throughout this book that should feel highlighted from the first page to the last is the need to balance advancing science and technology with individual human rights as well as responsibilities.

Bibliography

Finkel, Michael.  “Complications.”  The New York Times Magazine (27 May 2001): 26-59.

Henig, Robin Marantz. “The Quest to Forget.”  The New York Times    Magazine (4 April 2004):   32-37.

Kass, Leon R. “Why We Should Ban Human Cloning:  Preventing a Brave New World.” The New Republic (5.17.01). http://www.tnr.com/052101/kass052101.html

Mann, Thomas. The Magic Mountain. Trans. H.T. Lowe-Porter.  NY: Knopf, 1946.

Monastersky, Rich. “South Korean Researchers Harvest First Stem Cells From Cloned Human Embryo.”  The Chronicle of Higher Education,  February 12, 2004.           http://chronicle.com/prm/daily/2004/02/2004021201n.htm

 “Monitoring Stem-Cell Research.” The President's Council on Bioethics. “January 2004. http://www.bioethics.gov/reports/stemcell/index.html

Schweder, Richard A.  “Tuskegee Re-Examined.”  Spiked-Science (8 Jan. 2004):  www.spiked-online.com

     Chapter 4: Illness and Culture

An Analysis of Ken Kesey’s One Flew Over

the Cuckoo’s Nest and Alice Walker’s

Possessing the Secret of Joy

Introduction

           Ken Kesey’s One Flew Over the Cuckoo’s Nest embodies the rebellious energy of the psychedelic 1960s, a prosperous time following World War II when drugs were rampant, and the counterculture challenged authority.  A classic description of mental illness, Cuckoo’s Nest encapsulates Kesey’s experimentation with alternative forms of perception, while highlighting ethical issues.  The setting is a mental institution where a power struggle exists between the staff and the patients afflicted with many types of mental illness.  Paradoxically, reading this important novel feels liberating while it asks the disturbing question, who among us is completely sane? In fact, the United States has gone through a slow and arduous process to learn how to identify and to treat mental disorders.  Early on the mentally ill and retarded roamed the streets, were confined by relatives, or were thrown into prisons with criminals; later, psychoanalysis led to greater understanding.  Finally, in 1946 the National Institute of Mental Health was created, recognizing the need to diagnose and to help the mentally ill.  With the advent of mental institutions came radical therapies such as electroshock treatment and lobotomy. Today these controversial approaches are often replaced by psychotherapy, the so-called talking cure, and by drugs such as Prozac and Halcyon. With today’s brain scans and DNA analysis some mental disorders are more readily detected and treated.  Other topics Cuckoo’s Nest develops concern sexuality and institutionalization; humor and illness; nursing and group therapy; and psychiatry and surgery.             

 Kesey’s Cuckoo’s Nest continues to