BOOK REVIEW: The End of Trauma by George A. Bonanno

The End of Trauma: How the New Science of Resilience Is Changing How We Think About PTSDThe End of Trauma: How the New Science of Resilience Is Changing How We Think About PTSD by George A. Bonanno
My rating: 5 of 5 stars

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Out: September 7, 2021

The central idea of this book is that not everyone who’s exposed to traumatic events has long-term mental health effects. On average, two-thirds of those who suffer traumas show resilience. Bonanno’s experience working in the mental healthcare sector in New York City in the aftermath 9/11 impressed this truth upon him. The anticipated mental health tsunami never came; most people recovered and moved on with their lives.

It is hard to predict who that one-third is who will suffer long-term mental trauma. While there are some traits that correlate more to resilience and others to a proclivity to be traumatized, the fact that humans are complex and there are many confounding variables makes it immensely difficult to anticipate the impact of a trauma.

Given this difficulty, it’s beneficial to figure out how one can increase any victim’s resilience, and that’s the task the book engages. Bonanno discusses an optimal mindset for resilience that he calls the “flexibility mindset,” and he details a corresponding sequence (i.e. the “flexibility sequence”) that he suggests is the best known approach to reducing the adverse effects of trauma. As the key word, “flexible,” suggests, this approach requires adaptability. It’s not a one-size fits all approach, but rather hinges upon determining what coping strategies a person has access to, and then evaluating the degree to which they are working.

If found this book to be full of food-for-thought. I thought there could have been more elaboration of the dangers and limitations of distraction as a coping mechanism. To be fair, there is a discussion of this as he presents another therapist’s experience with, and thoughts upon, the “flexibility” approach, but that’s a bit late in the book. That said, I learned a great deal in reading this book, and thought it offered some excellent insights.

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BOOK REVIEW: (Mis)Diagnosed by Jonathan Foiles

(Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health(Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health by Jonathan Foiles
My rating: 4 of 5 stars

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Out: September 7, 2021

I’m fascinated by the challenges of mental health diagnostics. From the Rosenhan experiments (mentally well researchers checked into psychiatric hospitals) to the perpetual disappointment with new editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM,) a lot has been written about the difficulties of diagnosing disorders that largely express themselves through subjective experiences. Foiles’ book looks at how this challenge (combined race, gender, and gender identity biases) leads to differential diagnoses between various demographic groups.

The book serves as a call to action to be more aware of biases, and how they play into diagnoses. Though, in some cases it does a better job of that than in others. The six chapters present six faces of the problem: race and psychosis, race and ADHD [Attention Deficit Hyperactivity Disorder,] sex and Borderline Personality Disorder, and changing (though skewed) views of gender dysphoria, trauma, and intelligence.

Overall, I felt I learned something from the book, but sometimes it wasn’t as strong in supporting assertions and objectively presenting evidence as other times. For example, Chapter three examines how borderline personality disorder was (at least until recently) overwhelming seen as a female disorder. It went on to say that now it’s believed to have the same incidence in males, but that men present with different symptoms. To a neophyte, this sounds a lot like: “The Smiths eat meatloaf 50% of the time for dinner on Wednesday. Until recently, it was thought that the Joneses only ate meatloaf 10% of Wednesdays, but then it was discovered they also had meatloaf 50% of the time – but the Joneses meatloaf was made of ingredients such that it usually looked like chicken pot pie.] What?

For the most part, I found this book intriguing and informative, and would recommend it for those interested in the issue.

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BOOK REVIEW: Madness: A Very Short Introduction by Andrew Scull

Madness: A Very Short IntroductionMadness: A Very Short Introduction by Andrew Scull
My rating: 5 of 5 stars

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This is yet another of the many “Very Short Introduction” books from Oxford University Press that I’ve been pleased to read and review. The series offers concise overviews of a wide range of topics that are presented by scholarly experts. This particular book is a historical examination of the changing approaches to mental illness from the ancient world where such a condition might be attributed to demonic possession to more recent times in which drugs and decarceration / defunding of asylums have become the dominant approaches to mental illness. Along the way the book shines a light on the immense difficulty experts have had in understanding what mental illnesses are and how they can best be dealt with. The book not only looks at the real-world response to mental illness, but also explores how it’s been treated in fiction from “Hamlet” to “One Flew over the Cuckoo’s Nest.”

The book consists of six chapters. As one would expect of a book from a historian’s-eye view, its organization is chronological, but the arrangement of time periods by chapter reflects changing approaches to mental illness. Chapter one focuses on the ancient world, during which we begin to get glimpses of madness in the written record. Chapter two, entitled “Madness in Chains,” focuses on the 16th through 18th century, during which Bethlem [Bedlam] Hospital was the cutting edge. That the institution’s nickname becoming a synonym for chaos and confusion says a lot. It was a time of brutal measures that did little to reduce the trauma of mental illness. The chapter also discusses madness in Elizabethan literature, famously that of Shakespeare.

Chapter three shifts to the 19th century, an era in which incarceration became more widespread as well as coming to be thought of as the best that could be done for the insane. In Chapter four, we learn about the rise of psychoanalysis as well as the increasing employment of treatments that involved the physical body – infamously, the lobotomy.

Chapter five is one of the most intriguing parts of the book. Entitled “Madness Denied” it opens with an exploration of the difficulties that arose from all the war-related cases of mental illness that came about as a result of the two World Wars (and others.) It also discusses a movement to overturn the prevailing approach to insanity, most famously and vociferously argued by the Scottish psychiatrist R.D. Laing, a clinician who had a mix of promising and disastrous results from his experimental approach which used LSD, but few other medicines. What I found most interesting, however, was the discussion of the growing recognition that there was a false front in the idea that psychiatry was beginning to really understand mental illness and its treatment. This was exemplified by the Rosenhan experiments in which sane volunteers checked themselves into asylums and, for the most part, the doctors and staff couldn’t tell that they were sane (though, interestingly, in at least some cases the other patients did call it out.) The troubles in classifying and diagnosing mental illnesses have also seen in the vexed history of the “Diagnostic and Statistical Manual of Mental Illness” [DSM,] a guide meant to get mental health experts on the same page about what’s what. [As opposed to ten psychiatrists offering ten different diagnoses of a given patient.] While a worthy attempt, the DSM has not – thus far – succeeded, though it could probably be argued that progress has been made.

The last chapter brings the reader up to the current period, a period dominated by two trends – first, mental illnesses being treated overwhelmingly pharmaceutically; and second, the closing of asylums and the concurrent ill-effects that have come about, societally speaking.

The book has a few graphics, mostly black and white art and photos used to enhance the reading experience. There are also appendices of references and recommended readings.

If you are interested in the history of psychiatric medicine, I’d highly recommend you check out this brief guide. It may not give you all the information you’re looking for, but it’s a good first stop to organize your thoughts on the subject.

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BOOK REVIEW: Understanding Mental Illness by Carlin Barnes and Marketa Wills

Understanding Mental Illness: A Comprehensive Guide to Mental Health Disorders for Family and FriendsUnderstanding Mental Illness: A Comprehensive Guide to Mental Health Disorders for Family and Friends by Carlin Barnes
My rating: 4 of 5 stars

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This book is a concise overview of mental illness for individuals who don’t know much about the subject, and who may hold misunderstandings about mental illness and the mentally ill. If that’s what you’re looking for, you’re in the right place. If you’d like to know more about the variations in particular disorders or about relatively obscure conditions, you’ll probably find this book doesn’t meet your needs. The book advocates for doing away with the stigma associated with mental illness and having a better idea of the nature of mental disorders.

The book has fourteen chapters that are mostly logically organized. I say “mostly,” because chapters three, ten, thirteen, and fourteen deal in unique situations facing specific demographics (children / teens, the elderly, women, and professional athletes, respectively.) I’m not sure why these are spread out with topics that have a tighter logic interspersed in between them. I also am not sure why there is a chapter specifically dealing with professional athletes. Mind you, I understand the author’s argument about the unique mental health risks afflicting professional athletes and retired pro athletes. However, it seems like there are other careers that create unique problems (e.g. air traffic controllers) that touch more lives. Given the fact that an important part of the author’s message is about how those with mental health issues are frequently misunderstood and stigmatized, it seems like if one had to pick one career group to represent in the book, one would find one that is bigger and more relatable (e.g. military personnel, cops, social workers, therapists, or even poor / unemployed people.) If it was done to appeal to the general readership’s interest in celebrity, it’s a fail.

Chapters 1 and 2 set the stage by discussing what exactly a mental illness is, how it can be distinguished from the quirks that we all have in varying ways and degrees, and what the various causes are. Chapters 4 through 9 are the heart of the book, and present information on various mental illnesses by type (i.e. mood disorders, anxiety disorders, psychotic disorders, personality disorders, eating disorders, and substance abuse, respectively.) Chapters 11 and 12 discuss suicide and mass shootings, both are worthy inclusions.

The chapters discuss the clinical criteria for various ailments (which often seem arbitrary, but that’s part of the need for such a book – to give readers an understanding of the difficulty of diagnosing the mentally ill.) There are brief case examples included throughout to help the reader recognize the signs. That said, there isn’t a lot of room to deal in the tremendous levels of variation seen within given disorders.

There is an appendix with resources and links. Otherwise, there isn’t much ancillary matter in the book.

I would recommend this book if you are looking for a quick overview of mental illness with some presentation of typical examples. Particularly if you want a handy convenient guide without a lot of searching about. [Which is to say, I don’t think there’s a great deal that one would get from this book that one wouldn’t find doing some internet research.]

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BOOK REVIEW: The Collected Schizophrenias by Esmé Weijun Wang

The Collected Schizophrenias: EssaysThe Collected Schizophrenias: Essays by Esmé Weijun Wang
My rating: 5 of 5 stars

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Schizophrenia is ill-understood, and that’s just by psychiatrists and psychologists, the rest of us tend to downright misunderstand the condition. Wang’s book collects thirteen essays on her experience of living with schizo-affective disorder. I found Wang’s prose to be clever and engaging, though she does get into the weeds of technicality a bit in some of the early chapters. The book is not only well-written, it’s also brutally forthright. We hear a lot of how the author uses her alma mater (Yale) as a combination of sword and shield to combat the ever-present assumption she will be a stark-raving – not to mention dangerous — lunatic.

The book begins with discussion of diagnosis, but it doesn’t begin with her being diagnosed as Schizo-affective, but rather as Bipolar [formerly know as, manic-depressive.] There’s a great deal of discussion of the inexactitude of psychiatric science, and the fact that — to be fair — it’s not like every case is presents the same. The set of symptoms seen may create the potential to classify the same individual in different ways; hence, psychiatric diagnosis is often a long and winding road.

To list the essays with descriptions wouldn’t do them justice, so, instead, I’ll present some of the highlights. There’re a couple of chapters that look at how Wang tried to cope with, or counteract, the impression of people finding out she had schizophrenia. One of these involved the aforementioned repeated references to the Ivy-league institution that ultimately kicked her out and wouldn’t let her back in once she’d been treated and stabilized. Another was attachment to the label — and the idea — of “high-functioning,” which can be a hard sell for a condition like Schizophrenia. (Though not uniquely so. I once had a conversation with friend who didn’t understand that there could be such a thing as a “mild stroke.” This person believed that if one had any stroke one would surely be unable to talk correctly or have adult cognitive functioning. Though it occurs to me that my analogy is not entirely apt because anyone with a diagnosis of Schizophrenia will at some point experience severe symptoms – e.g. hallucination, delusion, etc. – otherwise they would be unlikely to be [rightly or wrongly] so diagnosed.)

There’s a chapter that deals with the question of having children. This brings up the twin questions of whether the schizophrenic can be a good parent throughout the development of the child, as well as how likely they are to pass on the trait through genes. [Those who’ve watched “A Beautiful Mind” will remember a scene in which the bathwater is rising on the baby because Nash is having an episode.]

Wang uses a number of sensationalist cases – e.g. murders – both to counteract the notion that all Schizophrenics are dangerous by contrasting with her own [more typical] experience, but also to let the reader know such extremes do exist. It should also be pointed out that one of these cases was the murder of a Schizophrenic by a family member who was living in terror that said schizophrenic (her brother) would ultimate kill her and her daughter, given the things he said and the auditory hallucinations he was said to have had.

One of the most interesting discussions for me was Wang’s description of leaving the Scarlett Johansson film “Lucy” asking her boyfriend whether what she saw was real. Everybody has that situation of being drawn into a film in an edge-of-the-seat fashion, but is fascinating to imagine a person who can’t disentangle from that state.

Chapter ten talks about the author’s experience with Cotard’s Syndrome. Cotard’s is a condition in which the individual believes they are deceased. I’ve read of Cotard’s in popular neuroscience books, but Wang’s first-hand account provides an extra level of connection to it.

The last essay discusses Wang’s pursuit of spirituality. It should be noted that in many tribal societies, Schizophrenics have been made shamans and are seen as having special powers. Wang doesn’t talk about this in great detail though she does a little [it is the premise of the series “Undone” on Amazon Prime], but it’s interesting to consider how religion and spirituality might influence the Schizophrenic mind.

I found this book fascinating and the writing to be elegant. I would highly recommend it for anyone with interests in the mind, mental illness, or just the experiences of other people.

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BOOK REVIEW: Anxious Joseph E. LeDoux

Anxious: Using the Brain to Understand and Treat Fear and AnxietyAnxious: Using the Brain to Understand and Treat Fear and Anxiety by Joseph E. LeDoux
My rating: 5 of 5 stars

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This book examines the neuroscience of anxiety, though psychology also makes a prominent appearance in the discussion – particularly toward the end of the book. It’s written by one of the top researchers in the field emotional neuroscience, though LeDoux discusses the work of other labs, comparing and contrasting their work with that of his own, and thus giving an idea of the fault lines in the field. (By that I mean more the questions that remain in dispute, not who hates whom.)

The book addresses a number of key questions such as: How does brain activity result in the emotional experience? How do conscious emotional feelings relate to and interact with non-conscious responses to threatening stimuli? Is the human emotional experience a hand over from animal ancestors or a uniquely human condition? How effective are drug-based versus psycho-therapeutic approaches to anxiety disorders? What has been learned about extinguishing anxious responses to threatening stimuli? Needless to say, this book doesn’t answer all the questions, as many of the questions – particularly those regarding consciousness – remain to be definitively answered. It does offer a great overview of the state of understanding in the present day.

I won’t present a chapter by chapter outline, but rather a look at the book’s general flow. LeDoux starts by laying groundwork, and in this case that means clarifying the relationship between fear and anxiety. While the former often captures the imagination because of its dramatic and traumatic causes, the latter is more of a concern as its grinding long-term effects can cripple the immune system and have other adverse effects. The early chapters also discuss what has been learned about how emotions are formed in the brain and how views about this have changed over time.

Chapter five is where LeDoux explores the relationship between animal emotionality and human emotional life. This is an important subject as it relates to the question of whether research with animals can teach us anything relevant to the human experience. As it has become progressively more difficult to conduct any research that causes human subjects any emotional distress, this question may be instrumental to making progress in the field.

Chapters six through eight are interconnected by the question of consciousness. Chapter six discusses the nature of consciousness, which remains one of the most slippery and least understood concepts in the natural world. Chapter seven delves into memory and consciousness – an important topic as anxious responses can be viewed as learned responses and this begs the question of unlearning. Memory will later be revisited with respect to the question of whether it’s possible to erase painful or anxiety-inducing memories (ala, “Eternal Sunshine of the Spotless Mind”) – based on work that came out of LeDoux’s lab – and, if so, whether it’s a good idea. The final consciousness chapter gets into consciousness of emotion, specifically (as opposed to all the other thoughts and feelings of which one can be consciously aware.)

The last three chapters are also interconnected by movement from the question of how is anxiety felt / experienced to the question of what one can do about it. The first of these chapters discusses an epidemic of anxiety (entitled “40 million anxious minds,” and that refers to the US alone) and what has been learned about drug-based treatments. As it happens, drug-based treatments haven’t proven reliably effective, leaving plenty of room for other approaches, e.g. psychotherapy. This fact is the basis for the last two chapters that discuss different approaches to extinguishing the connection between a stimulus and the anxious response. The first of theses chapters (ch.10) is more general and the last chapter dives deep into the research that has been done in recent years. Chapter 11 also offers a nice discussion of how breath exercises and meditation can be instrumental in reducing the adverse effects of anxiety.

As would be expected of a scholarly work, the book is heavily annotated, has an extensive bibliography, and uses a great number of graphics in an attempt to lend clarity.

I would put this work in the same category as the works of Robert Sapolsky. That is to say, it resides in a space between the level of detail usually seen in works of popular science and that which is seen in textbooks for specialists. That is to say, LeDoux does get into some detail and this isn’t a light read for anyone without a heavy-duty background in biological sciences. That said, if you have a basic scientific literacy (and / or don’t care too much about the fine detail), it’s by no means impossibly dense. When it’s not diving into the various brain regions and neuronal pathways, it’s quite readable.

I’d recommend this book for anyone who is interested in a detailed look at how anxiety arises and how it can be quelled.

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BOOK REVIEW: How to Change Your Mind by Michael Pollan

How to Change Your Mind: The New Science of PsychedelicsHow to Change Your Mind: The New Science of Psychedelics by Michael Pollan
My rating: 5 of 5 stars

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Psychedelics have been coming back into mainstream interest of late. Until recently, this renewed interest mostly occurred quietly through a continuation of scientific study, a promising line of inquiry that was aborted in the late 1960’s. There is growing evidence that these substances may be useful for combating depression, anxiety, and addiction – as well as their other, long-known benefits. (It should be noted that while it seems the writing is on the wall for these substances to become medically legitimate, it remains controversial whether they will be legalized for use by well individuals – though some were legalized in the US for a small religious group that takes them as a sacrament of their faith.) This book by the immensely popular immersion journalist, Michael Pollan, has brought the topic front and center into mass awareness, and may help turn the tide of a sullied public image.

Because these substances remain widely unknown or misunderstood, allow me to present some background — much of which Pollan discusses in varying degrees. Unfortunately, the term “psychedelic” has become so loaded with layers of meaning that it’s not optimal for discussing the topic at hand. Literally, psychedelic means “mind manifesting,” but its common meaning is tied up in notions of 1960’s counter-culture and even with styles of art and music. However, alternative terms are also troublesome. “Psychoactive substances” (i.e. chemicals that change mind states) encompasses a much broader selection of molecules and medicines – though it’s probably the most neutral term used popularly today. “Hallucinogens” is also problematic because a large portion of consumers of these substances don’t have hallucinations – at least not of the full-blown variety people normally associate with that term (i.e. seeing sights that one genuinely believes exist, but don’t.) Pollan opts to largely stick with the loaded term of psychedelic, and thus will I throughout this review.

Psychedelics are chemical substances that change one’s mindset, typically creating euphoria, shutting down “I”- centric parts of the brain such that one feels a “oneness” commonly described in the mystical traditions from around the world, and which, yes, often generate sensory experiences that aren’t reflective of the actual environment (hallucinations.) The downside is found in the fact that the substances produce constructive experiences, which means they amplify what’s in the subject’s mind, and, therefore, can result in “bad trips” in which people hallucinate terrifying products of their own subconscious mind. Pollan focuses heavily on three of the most popular psychedelics: psilocybin (naturally produced in a common species of mushroom), LSD (a chemical synthesized from ergot fungus that grow on rye), and DMT (which is most famously an active ingredient in Ayahuasca, a concoction long brewed by Peruvian Shamans.) Mescaline, which is well known from the writings of Aldous Huxley, is another popular psychedelic, but one which Pollan only mentions in passing.

To wrap up the background portion of the review, a little history. Psychedelics have been used by shamanic traditions around the world since time immemorial. In 1938, Albert Hofmann, a chemist for Sandoz Laboratories, accidentally synthesized LSD. That marked the (re-) introduction of psychedelics to the modern Western world (the ancient Greeks were believed to have mixed something with their wine that sounded like it had psychedelic properties.) Unbeknownst to most, between Hofmann’s invention and the late 1960’s, there was a promising line of research on the use of psychedelics for various conditions as well as in non-medical domains – e.g. relating the psychedelic experience to religious / mystical experience.

Unfortunately, there was a two-pronged turn of events that would end in these substances being made illegal and categorized “Schedule I” (which deems them not only risky / requiring care of use, but also denies they have any legitimate medical use – the latter seems to be proven demonstrably incorrect.) The well-known prong in the death of psychedelics resulted from the substances becoming tied into the 1960’s counter-culture, at first through shoddy scholarship by academics – most famously Timothy Leary – and then through recreational use that typically stripped away the rituals and “protocols” that had allowed shamans and mystics to safely use these substances for millennia. The second prong was government-sanctioned shenanigans in which LSD was used and misused in an attempt to create everything from truth serums to mind-control agents – most famously the MK-Ultra Program, and its sub-projects such as Operation Midnight Climax during which the CIA illegally used prostitutes to “roofie” their customer’s drinks with LSD so that a spy could covertly watch to determine whether the johns got loose-lipped or not. (Note: Pollan writes at length about the former aspect [i.e. Timothy Leary, Ken Kesey, et. al.] though not as much as books like Lattin’s The Harvard Psychedelic Club or Wolfe’s The Electric Kool-Aid Acid Test. However, Pollan only gives passing mention to MK-Ultra.) Psychedelics might have remained out of the popular consciousness and only of interest to the fringe of society that was involved with “hard drugs” had it not been (in addition to renewed scientific interest) for a blooming interest by Silicon Valley engineers and executives who took to “micro-dosing” psychedelics to obtain creativity gains.

Now, I’ll get to the review, proper: As I mentioned, Pollan refers to himself as an “immersion journalist,” which means that he provides a two-in-one book. The first element is what one would expect in a popular science book on psychedelics, i.e. he reports on the scientific findings, the key history and background information, and delivers quotes from people he interviewed. The second element, however, is description of his own psychonautic journey. Pollan consumed psilocybin mushrooms, LSD, ayahuasca (DMT), and also a substance excreted by a toad that lives in Mexico and the Southwestern US. The reader gets both Huxlian “trip reports” (though Pollan remains much more scientific-minded and less mystical than Aldous Huxley) as well as the objective overview of the topic.

The book consists of six chapters as well as front and back matter. The first chapter discusses the psychedelic “renaissance,” i.e. how it came to be that these substances brought back from the dead – i.e. being purely of interest to “druggies” and far-flung shamanic traditions. Chapter 2 deals largely with mushrooms, and specifically psilocybe mushrooms that are the most popular and common type of psychedelic mushroom. Pollan spent time with Paul Stamets, a world-renowned expert on all-things fungi and the man who – literally – wrote the book on psilocybe mushrooms. Chapter 3 focuses heavily on LSD, including its development and rocky history. The fourth chapter is a “travelogue” in which Pollan discusses his own experiences in taking these substances. The penultimate chapter is about the neuroscientific findings. There is much that remains to be known, but yet somethings are well-known. These substances generally mimic the neurotransmitter serotonin (though mescaline, for example, mimics dopamine.) There is also a fascinating discussion of how these substances may temporarily reduce activity in the default mode network, which is prominent in generating one’s sense of self. The final chapter examines the findings of research into the use of psychedelics as a treatment for medical conditions – particularly depression, anxiety (especially death anxiety of terminal patients), and addiction (contrary to a widespread notion, resulting from these substances being lumped in with “hard drugs,” psychedelics not only aren’t addictive, but – in many patients – they counter addictions to more dangerous drugs, such as alcohol – yeah, you read that right.)

The book contains the usual ancillary matter, including: a glossary, bibliography, and notations. As the approach is narrative, graphics are minimal.

I found this book to be highly informative and extremely readable. The use of stories to convey information makes it engaging while it educates. I would highly recommend this book for any readers who are interested in psychedelics as medicine or a mystical experience.

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BOOK REVIEW: Challenger Deep by Neal Shusterman

Challenger DeepChallenger Deep by Neal Shusterman
My rating: 5 of 5 stars

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“Challenger Deep” is the story of a smart and artistically talented young man, Caden Bosch, who is afflicted with Schizophrenia. There are essentially two story lines being told in parallel. One is the real world, and in the chapters in this line we see Caden’s descent as it takes place. From references to past events, we gain insight into how Caden was before the disease. In the early part of the book, these chapters are set at school and at home, and then later at the mental hospital at which he’s admitted as a patient.

In the other story, Caden is on a sailing ship headed to the Challenger Deep—the deepest portion of the Marianas Trench at almost 7 miles down, and—symbolically—Caden’s rock-bottom . Shipboard life is Caden’s hallucinated experience of the mental hospital. Over time the reader begins to match up characters from the real world with those from the delusion—both patients and staff members. This is a mutinous vessel, and the tension reflects the pull between Caden’s desire to be well and the appeal of the world of delusion.

Over time the author shows key events in both lines and the reader can connect them up to interpret how delusional Caden experiences the world. The story isn’t strictly told in a chronological order, though the broad sweep of it is. The bits of disjoint create no confusion while helping to convey the nature of a fractured mind. This works, in part, because the book is told over 161 short chapters, and, because the chapters are so short, a diversion doesn’t take one far and it’s easy to show the match up of events. The book artfully conveys the bizarreness of a dreamlike world of delusion while remaining clear and readable. Any confusion in the early chapters becomes rectified as the author reveals how the delusional world and the real world zip together.

This book was imaginative, enjoyable to read, as well as allowing the reader insight into the nature of mental illness. Atypical of a work of fiction, there is a resources section that provides contact information for organizations that support mental health.

I’d highly recommend this book for fiction readers.

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