Friday, November 21, 2008

AGAINST MEDICAL ADVICE

I was approached a little over a month ago, and was asked if I would be interested in reviewing a new book, Against Medical Advice (Little, Brown and Co., 2008). In the email I got from the publisher’s representative, I was told that I, and visitors to my blog would “find it very relatable and moving.” [Disclosure: I was sent a free copy of the book in order to read and review it.]

The book is written by James Patterson, the well-known novelist (Kiss the Girls; Along Came a Spider), and an old friend of his, Hal Friedman. Despite Patterson’s background as a writer of thrillers, this is a piece of nonfiction. It tells the story of the struggle by Friedman’s family to deal with “an agonizing medical mystery:” his son’s Tourette’s Syndrome.

I’ve been struggling with this review ever since I read the book. It’s not that I didn’t find it “very relatable and moving;” I did. I think it’s a very good book that’s well worth the time spent reading it. It’s just that I wanted to like it a whole lot more.

The book’s strong points are also its weaknesses. The story is told not from the standpoint of Hal Friedman or his wife, but rather it’s written as if by his son, Cory. This was done with the full cooperation of Cory (now a young adult), and is seemingly based in part on his own writings. Presenting the story with Cory’s point of view, filtered through the fast-paced style of an experienced novelist, takes the reader on a harrowing ride through what can only be described as Hell.
And Hell it was for Cory. His Tourette’s has unique aspects (some would call them comorbidities) that befuddled the “experts,” and made everything that much more difficult:
In sophomore year, it’s becoming clear that obsessive-compulsive disorder, or OCD, is a bigger part of my condition than we thought. Right now I’m mostly experiencing the kind of OCD they call intrusive thoughts ⎯ ideas that can take over your thinking. The worst thought I have now is that there’s no point to anything in life. This obsessive idea has suddenly paralyzed my desire to do anything . . .

The fact that the focus is on Cory’s own Hell rather than that of his family keeps it from becoming a “pity party.” On the other hand, knowing that the book was written as nonfiction by experienced writers makes the use of Cory’s point of view to be almost gimmicky at times. Moreover, there’s a lack of perspective, which can be somewhat effective but leaves the reader wanting more information that actually comes through.

And it’s that lack of information that is somewhat maddening. There are gaps in the chronological narrative that leave many questions unanswered. And indeed, one of the central questions the book raises ⎯ why Cory got better ⎯ is answered only by the educated guess of Hal Friedman in one of the few passages not told in Cory’s voice.

Enough information comes through, though, to make clear the real theme of the book: that the medical establishment the family relied upon to help Cory deal with his condition did nothing but make things a whole lot worse.

After years of being moved from one pharmaceutical to another, with ever-increasing dosages, Cory eventually resorts to self-medicating with alcohol. After a particularly bad episode involving alcohol, Cory wrote a long letter to himself, that includes the following:
Am I insane? It would seem so. I can’t stop hurting myself.
My parents don’t know what I’ve gone through. If they did, they’d be saying every word to me as if it were their last.
I deserve the world.
And I am stronger than the worst things that happen to me.

That episode is the turning point of Cory’s life. In the view of Hal Friedman, in the only chapter written in his voice rather than his son’s, Cory’s “recovery” comes about because “he made the decision to change.”

At some point, Cory’s parents joined in that decision as well. The opening chapter of the book relays the incident from which the title is drawn. Mr. and Mrs. Friedman are checking their son into a rehab facility to combat the alcohol addiction that is claiming their son. Cory is the one who recognizes that particular institutional setting will be a huge mistake, and he pleads with his parents to not leave him there. For the first time, the parents decide to trust their son’s instincts rather than the mainstream medical advice that has led them from one pharmaceutical product to another. They leave “against medical advice.”

Unfortunately, it is hard to tell just where that incident falls in the otherwise chronological narrative following that chapter. As most of the latter part of the book details Cory’s success with various programs and strategies, more context would have made that section stronger.

As I mentioned, the only part of the story told from the father’s perspective consists of a five-page epilogue, indicating that Cory’s improvement is attributed to Cory’s desire to get better, and also to the elimination of the “medications prescribed in good faith but with unhappy results.” Although Mr. Friedman uses the word “recovery,” it is acknowledged that Cory still experiences many clinical manifestations of his Tourette’s. It is unclear how much of Cory’s “recovery” is due to an acceptance of the level of the syndrome Cory lives with in the absence of the aggravating factor of being treated as a walking pharmaceutical experiment.

At 269 pages (not including some appendices), the book is a little on the “light” side. I think some time could have been devoted to the parent’s experience (including their expectations) without removing the focus from Cory. Moreover, giving voice to the parents might have made the representation of Cory’s perceptions to be less awkward.

All that being said, I liked the book ⎯ just not as much as I wanted to. Its flaws notwithstanding, it’s a good read.

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