More Than a Mere Read: Books with Lessons Teaching About Life

Once I learned to see my patients through the lens of a former flight attendant with the now defunct Eastern Airlines. A relaxed, easy-going receptionist in one of our group’s busiest family practices, she never seemed overwhelmed. Her apparent serenity, she explained to me, was because of the training her airline had given her in distinguishing amongst passengers’ needs. Their requirements, she said, depends on their personalities and that’s how she responded to them. Passengers or patients who had or created problems seemed to fall into a half dozen of types: those who had issues understanding complicated instructions were, of course, quite different from those who were difficult because they always needed to know exactly what was going on so they could be in control. She showed me her Eastern booklet that did, indeed, show a useful airline pop psychology of different types.

 

The pamphlet would have been a useful addition to any medical student’s lists; unfortunately, I no longer have it. The receptionist is now enjoying her retirement and not available.

 

But this incident is a reminder to me that we can learn about our patients and why they are what they are from many sources and not all from medical textbooks, some resources can even be as simple as crime fiction.

 

One author, the late Allan Folsom in his The Exile revealed as frightening an antagonist to any hero in his third book as one might find in the antisocial personality disorders of the DSM-5. Folsom died in 2014 of metastatic melanoma at age 72. The manuscript for his first novel The Day After Tomorrow (not related to the Tom Cruise movie of the same name) sold for the highest sum ever for a first novel; including film rights, it grossed close to $5 million. His five novels are all pretty intense and when a movie executive assigned an assistant to cut the material, she replied there was no way it could be cut. The movie was not made.

The late Stephen J. Cannell oddly enough died of melanoma too -- in 2010 -- and like Folsom, he also understood human weakness or pathology; his crime novel At First Sight portrays a criminal whose grandiosity and lack of empathy for others begins almost as mere humorous vanity then changes into a horrifying and lethal narcissism.

 

Jonathan Kellerman on the other hand is very much alive; he writes one or two crime novels a year. He wrote Guilt (his 28^th crime novel) in 2013 and has written three more since: Killer, Motive, and Breakdown. When you read the titles of some of his novels his background may become obvious: Bad Love, The Clinic, Survival of the Fittest, Flesh and Blood, A Cold Heart, Therapy, Rage, Obsession, Compulsion, Deception, Victims. Kellerman, one of my favorite crime authors, in fact has a PhD in clinical pediatric psychology and wrote text books on child psychology before he turned to crime fiction. He has now written more than 40, most about a child psychologist who is on a retainer of sorts with the LAPD for cases involving children. Although he is no longer active as a psychotherapist, he is a Clinical Professor of Pediatrics and Psychology at University of Southern California Keck School of Medicine and has written three text books on pediatric psychology and one on vintage guitars.

One thing I like about his fiction is how well he nails tiresome behavior which he scatters in some of his characters throughout the fiction, behavior that readers might feel they alone experience and detest in others – then, low and behold, it turns out Kellerman has noticed this too from the morose behavior of teenagers to the superiority complex of celebrities. It is patronizing of readers, no doubt, to show surprise that Kellerman shares our issues. He is, after all, a psychologist but it’s grand to get one’s dislikes validated.

 

So much for fiction.

 

But physicians searching for important conditions in life may have to look for similarly important nonfiction books on some subjects.

 

It would surely be hard to find a more confusing condition than autism. I am still a bit muddled even after reading Steve Silberman’s meticulously documented book. When I graduated as a physician from Edinburgh, Scotland in 1958, Johns Hopkins was the prime world authority on autism and Leo Kanner was King; he became professor of child psychiatry there in 1957 and professor emeritus in 1959.

 

I had no knowledge then of the Viennese physician Hans Asperger nor the paper he published in German just before World War II, although Silberman, the author of NeuroTribes, believes Asperger’s rival, Leo Kanner knew and minimized Asperger to discount his different opinion.

 

Rivalry between scientific experts is not unusual. It can be due to commercial interests as when two separate institutions working independently in the US and UK were isolating vitamin B12 in 1948 and wanted to find out how far along the other team was. “Our crystal has color,” one reported at a joint meeting. After some haggling, the other replied, “Ours is cobalt in color,” and now each knew they should pool resources. But sometimes scientific rivalry leaves cognoscenti uncomfortable such as how medical historians somehow credited Dr. Robert C. Gallo as the discoverer of the virus HIV in 1984 without realizing it had been sent him and identified by the Institute Pasteur in Paris in 1983.

 

A book NeuroTribes presents more than the legacy of autism; it discusses the theme of what is now called neurodiversity. It does so in the fascinating style of that great 1926 book Microbe Hunters by Michigan microbiologist Paul de Kruif that I see with pleasure I still available at Amazon.

 

I was initially horrified at how little criticism Silberman gave to the opinions of British gastroenterologist Andrew Wakefield whose fraudulent 1998 research paper endorsement of the false claims that vaccination was causing the rise in autism barely stirred Silberman in the first few pages but then after writing more than 78% of his book’s pages (418 pages of 534) he surely gets down to that in depth. But Wakefield, this disgraced physician who had his medical license taken from him in the UK, is still active and is now living in the US creating misleading documentary movies and “hellbent on protecting his legacy of disseminating misleading and harmful information about the link between vaccines and autism.”

 

But let’s look at something more honorable than Wakefields’ activity: Silberman’s book.

Book Review: NeuroTribes: The Legacy of Autism and the Future of Neurodiversity

 

We fool ourselves into thinking autism is a “puzzle”

that will be solved by the next medical breakthrough.

- Steve Silberman

 

This fascinating 534-page nonfiction book on the Legacy of Autism was published by Avery, an imprint of Penguin Randolph House LLC in 2015 at a time when the full story of this dreadful disease was still not completely understood. The situation remains unchanged today and the ongoing attempts to change the nomenclature and terminology has done little to help as the alphabet soup of parental organizations trying to help their patients simply muddied the waters. Silberman, an award-winning writer on science and cultural affairs for more than 20 years for Wired and magazines like the New Yorker, Time and Salon, meticulously researched the history of this elusive disease, interviewed many who were attempting to define it and spoke to and with many themselves on the autism spectrum.

At the height of what some have called the Autism Wars – when some researchers were blaming “toxic refrigerator” mothers for a child’s mysterious illness – Silberman’s investigations showed that all the multiple friends and parents of autistic children wanted the research into the disease. But not so much as to find the cause but instead improve the wretched paucity of social and supportive services to help those children – many of whom were being warehoused in institutions and considered mentally defective despite showing insight into their own condition because they were super-intelligent.

 

Silberman had what he called a deeply sobering communication with autistic families: “What every parent of a child on the spectrum knows is that, after high school, kids ‘age out’ of the very meager amount of services that are provided for them. Families often describe this process as ‘falling off a cliff.’ There are very few programs to help young autistic people transition out of school and into the workplace, even if they’re fully capable of working and very eager to work. Likewise, there are very few options for autistic people who are unable to live without significant support. Many parents of autistic children have told me, Silberman says, they lie awake, night after night, worrying about what will happen to their son or daughter after they die.’”

Unusual in a book report to have significant access to a book’s author but fortunately Silberman gave a TED presentation on why he wrote this book. His talk lasted less than 14 minutes but TED carries a transcript that is well worth reading and available here.

 

As if proving that autism is still not completely understood a flood of pseudo-experts still pours into the field with their own theories of this strange illness. The disgraced gastroenterologist’s vaccine theory still fascinates fearful parents with the resulting local epidemics of pertussis we have seen quite recently in California. “Our state really has all the American nuts and fruits,” a Californian pediatrician once told me.

 

Yet, one psychologist who makes widespread sense of it all is Mark Thorpe, a South African who earned his PhD at Rhodes University in 1989 and practiced in Cape Town until he emigrated to Auckland, New Zealand in 1994 where he lectured in the department of psychiatry at Auckland University. He is now head of the department of psychology there.

Thorpe, like Silberman, has helped to bring Asperger out of the shadows. Thorpe’s web pages like Silberman’s book offer huge historical insights into the world of autism.

Thorpe’s lecture slides show his whimsical side by including Spock from Star Trek.

Thorpe compares those patients to those with narcissism who are “charming but take up all the oxygen in the room and squeeze the therapist out.” His slides show the differences.

He feels however that many successful people have actually been on the high end of the Asperger spectrum. It’s a lesson physicians get all the time in our crazy world.

Silberman makes his points in a 500-page book. We will let Mark Thorpe make his is another of his slides

 

Photography by the author. Images copyright Eric Anderson.

 

The Andersons, who live in San Diego, are the resident travel & cruise columnists for Physician's Money Digest. Nancy is a former nursing educator, Eric a retired MD. The one-time president of the NH Academy of Family Physicians, Eric is the only physician in the Society of American Travel Writers. He has also written five books, the last called The Man Who Cried Orange: Stories from a Doctor's Life.