Nonfiction November – Be the Expert

This week’s Nonfiction November topic gives us lots of choice!

NonfictionNovember-e1506979820517Three ways to join in this week! You can either share three or more books on a single topic that you have read and can recommend (be the expert), you can put the call out for good nonfiction on a specific topic that you have been dying to read (ask the expert), or you can create your own list of books on a topic that you’d like to read (become the expert).

I have decided to Be the Expert in medicine, more specifically “books by doctors doing their thing awesomely”.  I’m a medical interpreter and work in hospitals, so it’s a topic that’s close to my heart.  After I made the list I realized all the authors are women – extra bonus!  The titles link to my full reviews.

15998346 What Doctors Feel: How Emotions Affect the Practice of Medicine by Danielle Ofri, MD

Each chapter covers an emotion doctors deal with on a near-daily basis, from empathy and fear to sadness and shame.  Good practices are shared and less than ideal situations analyzed in solid, assured prose that is still honest about the author’s misgivings and failings. The feelings behind what your doctor is thinking.

29955558Committed: The Battle Over Involuntary Psychiatric Care by Dinah Miller, MD and Annette Hanson, MD

Involuntary care is a a minefield of ethical conundrums and this book covers as many points of view as possible, from pro-involuntary treatment groups to anti-anything-psychiatry groups like Scientology. Thorough, well-considered, and fascinating.

19967171Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner by Judy Melinek, MD and T.J. Mitchell

The training and most memorable cases of a medical examiner.  While the jacket copy teases the stories around terrorist attacks my favorites were more commonplace – injuries that only show up after a day has passed, how to figure out which stab wound came first, pinning down someone’s age thanks to a single rib bone. Riveting and perfect for anyone who perks up when Law and Order heads to the morgue.

I’m always on the lookout for more medical nonfiction – what’s your favorite?

Committed by Dinah Miller and Annette Hanson

Synopsis:

29955558Psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy–all within the context of civil rights–Miller and Hanson illuminate the personal consequences of these controversial practices through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it.

The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions–mental health court, crisis intervention training, and pretrial diversion–that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public.

Review:

Involuntary care is a a minefield of ethical conundrums.  How do you decide who needs treatment?  What if the patient calmly refuses it?  Will the treatment itself be more traumatizing than beneficial?  How can you ethically hold people against their will?  And when is it okay to let them go?

Miller and Hanson cover as many points of view as humanly possible, from pro-involuntary treatment groups like the National Alliance on Mental Illness to anti-anything-psychiatry groups like Scientology.  (Yes, they managed to interview a Scientologist for this book.  It’s kind of amazing.)  There are all kinds of opinions between the extremes that are also covered – those who would rather see outpatient commitment instead of inpatient, for example, and people who want to help patients recover with or without medication.  They also speak with professionals that are involved in the civil commitment process, from judges and lawyers to police officers and ER doctors.

There is a ton of information but it never gets overwhelming.  The narrative is loosely hung on the cases of two patients, one who had a positive experience with involuntary care and one who was traumatized by her time at the hospital.  Though interviews with these patients, their families and doctors, and peeks at their medical charts, we see how forced care could be the best or worst thing to happen to someone.  Their journey is covered from being picked up by police or brought in by a family member, through civil commitment trials and treatment, to how they were determined to be fit for release.

Laws widely vary across the United States and their differences are an illustrative example of what policies seem to work and which should be rethought. As a result Committed gives you a framework of possibilities that you can use to examine the laws that affect you, no matter where you live.

The thing that strikes me most about this book is the care and consideration that went into it.  Miller and Hanson, psychiatrists, never deride anyone for their views. They sat across the table from people who think their profession is basically evil and held a civil, thoughtful conversation. If there’s an outrageous factual error they’ll mention it in passing with research to back them up, but otherwise everyone is allowed to say their piece exactly as they’d like in a non-confrontational environment. Mad props.

They’re also forthcoming about the circumstances surrounding their reporting.  Getting an inpatient unit to agree to Miller observing was harder than they thought, and they are upfront with the fact that the only hospital that would agree has one of the best psychiatric departments in the country.  And try as they might they couldn’t get anyone to talk about guns and mental illness on the record.

Doctors, [the gun club representative] noted, are seen by gun owners as an extension of the government. …people were happy to engage in casual conversation, but before they would speak in depth, they wanted reassurance that we were not in favor of gun control, regardless of whether that was relevant to the topic of the book.

Any time I thought there might be a hole in the reporting or an odd circumstance it was covered in this thorough, thoughtful manner. The authors have earned all of my respect.

Committed is a must read for anyone whose job brings them in contact with people with psychiatric illness as well as anyone with an interest in civil rights.  And if you’re curious about how mental hospitals work (aren’t we all?) it’s a fascinating look at this “hidden world, open only to those who are in enough despair to gain admittance”.

Thanks to Johns Hopkins University Press and Edelweiss for providing a review copy.


You may also enjoy:

9827786 Shrink Rap by Dinah Miller, Annette Hanson, and Steven Roy Daviss

Shrink Rap by Dinah Miller, Annette Hanson, and Steven Roy Daviss

Synopsis:

9827786Finally, a book that explains everything you ever wanted to know about psychiatry!

Based on the authors’ hugely popular blog and podcast series, this book is for patients and everyone else who is curious about how psychiatrists work. Using compelling patient vignettes, Shrink Rap explains how psychiatrists think about and address the problems they encounter, from the mundane (how much to charge) to the controversial (involuntary hospitalization). The authors face the field’s shortcomings head-on, revealing what other doctors may not admit about practicing psychiatry.

Candid and humorous, Shrink Rap gives a closeup view of psychiatry, peering into technology, treatments, and the business of the field. If you’ve ever wondered how psychiatry really works, let the Shrink Rappers explain.

Review:

As a medical interpreter I relay what was said in one language in another, so technically I only have to grok the words. However it helps if I know what the speakers are thinking and why they say the things they do. In many cases the patient’s thoughts are simple: “OW. Ow ow ow ow ow – a little help here?” In acute cases the questions make sense: “You have a fever, ache, and chills… have you been in contact with anyone who has the flu?” The one specialty that tends to throw me off, though, is psychiatry. Questions seem to come out of left field and I have no idea what’s going on in the doctor’s head.

Luckily the three doctors who wrote this book have my back. They each have a different area of expertise – hospital psychiatry, forensic psychiatry, and psychotherapy – and their combined depth of knowledge is evident and awesome. We’re shown scenarios with fictitious patients, explaining why the (also fictitious) doctors ask the questions they do, when and why certain medications should be avoided, and what they hope the patient will achieve via treatment.

This look inside psychiatrists’ heads was invaluable for me. I was able to think about cases I’m familiar with and finally realize why a certain medication was stopped, or why the doctor asked a seemingly unrelated question. I have yet to interpret in an institutional setting but I now feel much more prepared to tackle a jail or involuntary hospitalization assignment. The legal system is different where I am, of course, but the basic tenants of treatment remain the same.

In a similar vein, there is a lot of discussion about how psychiatrists are reimbursed and how this or that insurance authorizes treatment. It isn’t relevant to me, and things have probably changed under the Affordable Care Act, but it’s still interesting.

The writing is clear and easy to follow, striking a balance between jargon and a more general writing style. If you have some kind of contact with mental health professionals (like me) or an interest in the area you’ll love Shrink Rap. I’m not sure I would push it on friends not into medical non-fiction, though – give them some Mary Roach first.