Doctor Zhivago

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The Doctor Zhivago Plot

The CIA was known for unorthodox espionage techniques during the Cold War, but using Doctor Zhivago to undermine the U.S.S.R. is one of the strangest. The CIA helped print and distribute the banned book because it would make Soviets wonder “what is wrong with their government, when a fine literary work by the man acknowledged to be the greatest living Russian writer is not even available in his own country in his own language for his own people to read.”

Planes, Trains, and Automobiles: Recommended Reading for Transient Lives

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A recent Millions essay by Michelle Huneven got us thinking: much hay has been made of how various print and digital platforms affect reading practices, but what about setting? Where you do your reading, and how much unbroken time you can give to it, will arguably shape your experience far more than does the difference between screen and page. And as cable and the web colonize our homes, it seems to us that the best reading is increasingly done in transit – for better and for worse. We’ve read pieces of War and Peace on the DC Metro (tough) and half of Anna Karenina in a single gulp on a night train through Tuscany (sublime).

By way of starting a conversation about the ideal marriage of text and transportation, we’ve asked our contributors and our Facebook group to make recommendations for three modes of transportation: Planes, Trains, and Automobiles. “Planes” should be self-explanatory; “Trains” comprises commuter rail (and buses) as well as longer distance trips; and “Automobiles,” perforce, centers on audiobooks, podcasts, and works read out loud by those not behind the wheel. Contributor responses appear first, followed by selections from the Facebook response. We invite you to add your own in the comments section or via twitter (using the hashtag #roadbooks). Bon voyage!

Planes
Sonya: While traveling far from home, I like to give myself over fully to a changed perspective, leaving my customary myopia behind as much as possible; The Economist is my preferred reading. The robust  “World” and “Business” sections in particular knock me off my precious literary perch, which can be awfully refreshing.

Kevin: My criteria for a plane book are two: I want it to be fast-paced, and I want to be able to finish it, if not by the time I touch down, then at least during the return flight home.  I’ve never had a better plane reading experience than Boston to Los Angeles, 1994, The Hunt for Red October.

Edan: When flying, I always want something short enough to read cover-to-cover (in addition to a novel, a fashion magazine or gossip rag, and a book of jumbles, crosswords, or soduku). On my last few flights, I’ve brought a volume from Melville House’s Art of the Novella series. I’ve written about Bonsai by Alejandro Zambra here. I can also recommend Customer Service by Benoît Duteutre, about a man with cell phone issues who just wants help from a goddamned human being. It’s an appropriate read for when you’re flying through the air in a magical bullet, and you’ve just been forced to pay for a bag of peanut m&ms (a.k.a., dinner) with your credit card because cash is no longer accepted. 

Garth: Last summer, en route to Hawaii, I read most of Gay Talese’s Thy Neighbor’s Wife. If I say that I wasn’t even tempted to look at The Real Housewives of New Jersey (on a continuous loop on my back-of-seat TV), it’s not to slight Jacqueline or Dina, but to indicate how engrossing and provocative I found Talese’s exploration of sex in America.

Anne: For the nervous flyer (like myself), who wants to forget they’re in a fuselage for the duration of the flight, Lucy Grealy’s memoir Autobiography of a Face offers a gripping and unsentimental account of her childhood bone cancer and living with the consequent facial disfiguration. The book can captivate for the time it takes to cross an ocean – even, in my case, the Pacific.

Emily W: My fear of flying makes reading when skybound a rare pleasure. For me, it’s usually the iPod, cocktails, and a Vogue or a Harper’s Bazaar. The one book that managed to suppress my fear of death in the sky for five hours was J.M. Coetzee’s Disgrace, which I read from cover-to-cover on a red-eye from San Francisco to DC. 

Max: Plane rides are perfect for magazines, especially the New Yorker. The freedom to work through an entire issue in one sitting feels like a luxury, even if the leg room is lacking.

Amir Hother Yishay: I read my first Murakami on a transatlantic flight, Kafka on the Shore; a magical experience. Also, White Teeth by Zadie Smith.

Becky Donahue: On one flight to Germany, I could not put down The Devil in the White City… wonderful. Another great plane book was the biography of John Adams by David McCullough.

Trains
Anne: Amy Hempel’s Collected Stories offer enchantments brief enough for daily a commute, but the collection provides a cornucopia of word play and eclectic tales to occupy a longer haul. Plus, Hempel’s story, “To Those of You Who Missed Your Connecting Flights Out of O’Hare,” is a sure endorsement of the soothing lull of a long train ride.

Sonya: I like the Russians for train travel. When you’re watching the natural landscape – the largely uninhabited regions – of a country fly by in flashes, it just feels right to be reading stories that take place over the great land mass of Mother Russia. For a long trip, Dr. Zhivago; for, say, the DC-New York Metroliner, Chekhov’s “The Steppe” – in both cases, the land journey is also the journey of the soul.

Garth: The subway is feast or famine for me. The right book, and I’ll miss my stop; the wrong one, and I’ll read for half an hour without registering a single word. When I don’t have a New Yorker handy, Joan Didion – say, Play it as it Lays or Salvador – is perfect subway reading: lucid enough to let me in quickly; sophisticated enough to hold my attention; and discretely structured, for ease of exit.

Kevin: Typically before boarding at 30th Street Station in Philadelphia, I stop at a news kiosk and pick up the NYT and the WSJ.  I enjoy having the time to read each front to back, and I like being able to change from news to business to sports and then back again.  There’s also no doubt that I like the romance of a newspaper on the train: the economy fold, the crinkle of the pages mixed with the sound of the clattering tracks.

Emily W: On trains, I’m usually one for gazing out the window or striking up a conversation with a stranger, but this winter on the Northeast Direct from DC to Boston, I found Poets and Writers’ January/February 2010 issue quite absorbing, particularly their “Literary Life” essays.  I’m a bit of skeptic when it comes to writing about writing but P&W convinced me otherwise.

Edan: I never travel by train, but the next time – or, really, the first time – I get the opportunity to ride one across the country, or even state lines, I plan to bring along my copy of Selected Stories by Alice Munro.  I will flip immediately to “Wild Swans,” a startling, discomfiting, and accurate account of an encounter with a stranger on a train. Munro writes: “Victim and accomplice she was borne past Glasco’s jams and Marmalades, past the big pulsating pipes of oil refineries.”  I’d like to read that sentence as another landscape glides by my own train car window.

Max: There’s something about taking a longer train ride that puts one in the mood for adventure. When I was younger, I read Fear and Loathing in Las Vegas on a train ride from Washington D.C. to New York and emerged from Penn Station feeling pleasantly addled and ready for a night on the town.

Amir Hother Yishay: I finished the last 200 hundred pages of A Storm of Swords, by George R.R. Martin, on a subway ride

Jane Weichert: Nothing Like It in the World by Stephen Ambrose is an very readable story of the building of the first transcontinental railroad. It was built by the immigrant Chinese and Irish and gives an understanding of the brutal conditions under which they worked. Last Train to Paradise by Les Standiford is a spell-binding tale of the last of the privately financed infrastructure projects undertaken by larger-than-life 19th century businessmen. Here Henry Flagler races against his own mortality to complete a railroad from Jacksonville to Key West, with the final run south from Miami requiring herculean engineering, management, and financial resources.

Becky Donahue: Short stories are wonderful…just finished reading Too Much Happiness by Alice Munro. Podcasts…Slate does a great job and lots of content to choose from. My new favorites are Spilled Milk and The Moth.

Automobiles
Sonya: Once weekly, I drive two hours each way – prime audiobook time. “As read by the author” is often a great way to go when choosing nonfiction in particular.  I recommend Elizabeth Gilbert reading Eat, Pray, Love; Anne Lamott reading any of her memoirs; Helene Cooper reading The House at Sugar Beach; and, my favorite among these, Dreams From My Father. The author was allowed much more range of expression back in 2005 when he recorded it, and it’s a rare experience hearing a future president do Kenyan accents and urban “Negro dialect” (ahem) and using the f- and n-words. [Ed.’s note: for the latter, we also recommend the Lyndon Johnson tapes.]

Anne: It’s rare that I travel by car these days, and even rarer that I find myself behind the wheel, but when I do, I like to listen to In Their Own Voices: A Century of Recorded Poetry. Listening to poems, like songs, lets me internalize their rhythms and cadences. This collection features a wide range of twentieth-century poets reciting their own poems, from Sylvia Plath’s contemptuous “Daddy” to Gertrude Stein’s playfully repetitive “If I Told Him: A Completed Portrait of Picasso.”

Emily W: With audiobooks, it’s all about the reader; audio samples are essential to choosing a good recording. On recent car trips, my husband and I have found Huckleberry Finn and The Da Vinci Code particularly entertaining (in the latter case, guffaw-inducing) because the readers were so excellent at accents, genders, and dialects. And I have extremely fond memories of listening to Larry McMurtry’s Anything for Billy with my parents and sisters on a childhood drive from Virginia to Massachusetts. 

Kevin: Audiobooks are not foolproof.  A couple years ago I tried to listen to Cold Mountain on a road trip; between changing lanes, counting out toll money, and generally trying to stay alert, I found Charles Frazier’s slow, somnolent reading impossible to follow.  These days my voices of choice are David Sedaris (yes, please, Santaland Diaries one more time) and Garrison Keillor, or anyone else working in short-form comedy.

Garth: Though my wife and I like to read aloud to each other on long trips, The Lannan Literary Foundation podcasts are a recent discovery I’m pretty enthusiastic about: lengthy readings by writers like Deborah Eisenberg and Samuel R. Delany, followed by intelligent discussion with peers like Ben Marcus and Junot Díaz. We parcel them out like rest stops.

Max: A good travel audiobook can make even a drive from Chicago to New York seem something more than just endless fields and turnpikes. Most memorable was Paul Theroux’s account of his train trip from Cairo to Johannesburg, Dark Star Safari. The library is great for these.

Amir Hother Yishay: I always read on car rides, never having been a fan of audio books myself. One of my greatest car reading experiences would probably be reading One Hundred Years of Solitude over a two week trip from Toronto to St. Johns.

Miriam Parker: One of my most enjoyable long car rides included listening to Born Standing Up by Steve Martin. He reads it and is fantastic. I actually had to stop the car once to write down something brilliant he had said or else I would have caused a huge accident on I-40.

Becky Donahue: Firstly I love audio books. I re-read (or listened to) Lovely Bones. Bel Canto (Ann Patchett) is a good audio book. And anything from Neil Gaiman…brilliant.

Christine Magee: Commuting in and out of the city on a regular basis last year was made palatable by listening to Carson McCullers, The Heart is a lonely Hunter. The fact that the narrative transported me to a different place and time made it the perfect choice. It got to the point where I was looking forward to sitting in traffic so I could hear more! This wonderful book full of tension and struggle made my daily commute seem like a breeze!

The Millions Interview: Richard Pevear and Larissa Volokhonsky

The Russian language is the real hero of Tolstoy’s masterpiece; it is his voice of truth. The English-speaking world is indebted to these two magnificent translators, Richard Pevear and Larissa Volokhonsky, for revealing more of its hidden riches than any who have tried to translate the book before. — Orlando Figes

After reading their 2007 translation of War and Peace, Orlando Figes, the eminent Russian historian, did not mince words about Richard Pevear and Larissa Volokhonsky. And so, neither will I: When I found out that I had the opportunity to interview the translators, I was giddy as a girlish Beatles fan circa 1964.

As the bestselling and award-winning translators of sixteen great works of Russian literature, Pevear and Volokhonsky are something of a rock star duo in the literary world. The fluency of their translations, grounded in a nuanced understanding of the time and place that the source texts were written, have given cause for many of us to fall more deeply in love with The Brothers Karamazov, Crime and Punishment, The Idiot, Notes from Underground, The Master and Margarita, Dead Souls, and the fiction of Anton Chekhov, among many others. The pair have been working together since 1986; Pevear has also published individual translations from French and Italian. As a duo, they were twice awarded the PEN Book-of-the-Month Club Translation Prize. Their 2004 translation of Anna Karenina was an Oprah’s Book Club pick.

The couple, who are married and live in Paris, added a new title to their oeuvre just last month: The Death of Ivan Ilych and Other Stories, by Leo Tolstoy. The collection includes eleven glittering and strange tales, among them “The Kreutzer Sonata,” “Master and Man,” “The Prisoner of the Caucasus,” and the novella Hadji Murat, which was Tolstoy’s final work. While Pevear and Volokhonsky have previously translated the short fiction of Fyodor Dostoevsky, Anton Chekhov, and Nikolai Gogol, this is their first turn at the stories of Tolstoy. The ones they’ve chosen are largely from Tolstoy’s later years; together, the stories wrestle with questions of war, honor, death, sex, obsession, resentment, redemption, crime, and innocence. Seven of the stories collected were never published in Tolstoy’s lifetime.

So how do they do it? Pevear and Volokhonsky are candid about their tag-team approach to translation. Volokhonsky, a native speaker of Russian, pores over the original text first and creates a transliterated draft marked with her comments about the author’s literary style. Pevear, who does not read Russian, works from that draft to polish the English text, discussing pressing questions that emerge along the way with Volokhonsky. Should any disagreements emerge, Pevear makes the call. As Volokhonsky recently told Jeffrey Tractenberg in the Wall Street Journal:

Richard is a native speaker of English. I’m a native speaker of Russian. My task is to explain to Richard what is happening in the Russian text. Then it is up to him to do what he can. The final word is always his. I can say this is not quite what the Russian says. Either he finds something that satisfies me or he says no, this is how we’re going to do it. We discuss endlessly and sometimes it becomes a nuisance because we return to it again and again even after the manuscript goes off. But we really don’t quarrel. It would be much more interesting if we did.

Pevear and Volokhonsky do agree, however, to refrain from using contemporary expressions in their translations, choosing to remain faithful to the style of the novel’s time. Their current project? A translation of Boris Pasternak’s Doctor Zhivago.

In kind with their team approach, Pevear and Volokhonsky approached this email interview for The Millions as a pair.

The Millions: Your newest translation together is The Death of Ivan Ilyich & Other Stories. Why did you choose to do this particular book?

Richard Pevear and Larissa Volokhonsky: Quite simply because these later stories are among Tolstoy’s greatest works. In fact, the short novel Hadji Murat is perhaps the finest thing he wrote, and he seems to have known it. After all his storming against the notion of beauty, he could not help himself, being a born artist, and “in secret from himself” (as he put it) wrote his most perfectly beautiful work – “beautiful” in the way that The Iliad is beautiful. “Master and Man” is also a perfect work of a very different sort, vividly told and deeply moving. But even the opening story of the collection, “The Prisoner of the Caucasus,” which he wrote for a children’s reading book in the simplest style possible, is gripping and unforgettable. How could we not want to translate them?

TM: Having also translated War and Peace and Anna Karenina, what have you found to be unique about how Leo Tolstoy worked in short fiction, compared to his novels?

RP and LV: Tolstoy’s two big novels, like almost all of his work before 1880, portrayed people of his own class, the landed aristocracy, and their social milieu. Most often his heroes were self-conscious men, seekers of the meaning of life – in other words, self-portraits to one degree or another. In his later stories, there is much more variety: one hero is a narrow-minded bureaucrat, another is a well-to-do peasant, still another is a sort of holy fool, and finally there is the Chechen chief Hadji Murat. “The Forged Coupon” portrays people from all levels of Russian society, from the tsar to the lowest criminal. And there is a corresponding variety of “worlds.” That’s one thing. Another is the effort Tolstoy made to rid his art of what he considered the “superfluous detail” of the novels. His compositions became tighter, more formal, without losing any of the sensual immediacy that was the essence of his art.

TM: What are the greatest misconceptions about Tolstoy?

RP and LV: The greatest misconception might come from believing what Tolstoy said about his artistic work after his “conversion to true Christianity,” as he called it; that is, from believing what he preached in the series of tracts and polemical works he wrote after 1880. He was never able to practice what he preached. He remained a deeply divided and contradictory man all his life. And that nourished his artistic work. We took a phrase from W. B. Yeats as the epigraph for our introduction to Anna Karenina: “We make out of the quarrel with others, rhetoric, but of the quarrel with ourselves, poetry.” That is even more true of Tolstoy in his later works, because his inner quarrel was more intense. “The Kreutzer Sonata” was meant to teach a lesson about the evils of modern marriage, but it does something quite different and humanly much more complex. Another misconception is that Tolstoy only wrote those two huge, unreadable novels.

TM: Together, you’ve worked your way through some of the greatest fiction ever written. What are the unique pressures you have as translators of fiction that is both beloved and so highly regarded?

RP and LV: The pressure comes more from the quality of the writing itself. There are two questions that it might seem quite proper for a translator to keep in mind, but that in fact will spoil the translation. The first is, “What will the reader think?” And the second is, “How do we say that in English?” A good writer does what he or she has to do in the writing so that it “goes right,” as Robert Frost put it. There is at least as much intuition as intention in the process. A good translator has to follow that process far more consciously than the writer and yet come as close as possible in the new language to the instinctive “rightness” of the original. The greater the writer, the closer you want to come. That is both the challenge and the joy of it. But exactly what that “rightness” is remains undefinable, which is why there is no such thing as a definitive translation.

TM: Only about three percent of books published in the U. S. are in translation; the rate is even lower for translated fiction. What do you make of these numbers?

RP and LV: There are a number of things that might be made of them. The percentages are much higher in Europe, of course – 12% in Germany, 15% in France, 24% in Spain. We might say that that’s because Europe is small, a sort of family of countries, despite all past wars and present rivalries. And so translation comes naturally, like overhearing a conversation in the next room. But the analogy doesn’t quite work, because Europeans also translate a great deal of American writing and writing from all over the world. And Russia, which is a rather large country, has always given great importance to literary translation and has produced many superb translators. Is it American insularity, then? A lack of curiosity about what happens elsewhere? But what about the statistics for Great Britain? Surprisingly, they are about the same as for the U. S. Which suggests a linguistic insularity specific to English itself: if you speak the language of the hegemony, why notice the babble going on around you? It might also be a question of the market and marketing. Americans read an enormous amount of junk, which is dutifully supplied to them by publishers – unless it is actually the publishers who create the taste for junk. In either case, publishers are not likely to pay for the rights to translate junk and turn over a good percentage of the book’s earnings to the original publisher. They tend to pick up the small number of books that win the major European prizes, hoping that the momentary notoriety will create a market among more discerning readers with a minimum of advertising. But, on the positive side, we do have publishers who have consistently gone against the market statistics and made a point of publishing translations: Dalkey Archive Press, for instance, and first of all New Directions. Among major publishers, Knopf, Vintage, and Everyman’s Library, who publish most of our translations, are the exception that proves the rule.

TM: Your translations have achieved immense acclaim and success. Particularly in context of the low numbers of translations in the U. S., as well as the many other versions available of some of the books you work on, what is it about your translations that resonates with readers?

RP and LV: We’re the last people who can answer that question.

TM: Russian or otherwise, who are the writers you’d most love to see translated into English? What books are U. S. publishers and readers lacking?

RP and LV: There are three fine Italian writers of the twentieth century who should be translated into English: Alberto Savinio, Cristina Campo, and Guido Ceronetti. A very few of Savinio’s many books have been translated and gone out of print. One book by Ceronetti (who is still living) was published by Farrar, Straus in 1993. No English translations of Campo have been published as far as we know. Then there is the French poet Jacques Darras, who is incidentally a major translator from English. Some of his more scholarly books have been translated, but not his remarkable poetry and artistic prose. And there is the fine essayist and “culturologist” Sergei Averintsev, one of the most important Russian thinkers of recent times, a brilliant and witty writer. A few of his essays have been translated into English, but nothing like the substantial collections available in Italian, German, and French (the French publisher Cerf has recently commissioned a translation of Averintsev’s complete works).

TM: What books have you decided not to translate, and why?

RP and LV: We have decided not to translate Turgenev, because not everyone can be Mrs. [Constance] Garnett.

TM: Does contemporary literature lack the deep engagement the Russians had with the mysteries of life, like the existence of God and the meaning of death? If so, why do you think this is and what is lost?

RP and LV: These questions are very difficult to talk about or even to formulate correctly. They lead to glittering generalities that are almost certain to be wrong. But we might say tentatively that the qualities we find in nineteenth century Russian literature came in part from the late maturing of Russian culture, which reached its “golden age” not in the time of Shakespeare or Molière or Cervantes, but in the age of Pushkin, Gogol, Dostoevsky, and Tolstoy. These writers belonged fully to the nineteenth century, with all its social and spiritual conflicts, but at the same time they were creating the language and the forms of their literature, and posing these “accursed questions,” as Dostoevsky called them, for the first time. There is a primary energy in their work. As for what may have been lost, writers themselves have little choice about these things; they are determined by forces much larger than the individual will. Besides, what is lost here is found there.

TM: What is the social resonance of Tolstoy’s ideas today? Why do we keep turning back to him?

RP and LV: There are people all over the world who are still taken with Tolstoy’s social ideas – that is, with “Tolstoyism,” as he and his followers defined it: the radical simplification of life, egalitarianism, non-violent opposition to the state, pacifism, vegetarianism, post-marital chastity. But that’s probably not what you mean by “Tolstoy’s ideas.” We turn back to him, we keep reading him, because in his artistic work he deals with universal conditions and almost never with topical issues, and because he has such an extraordinary gift for concrete realization.

TM: Judging by your output, you both seem to work so much and so efficiently. Do you have time to read for pure enjoyment? If so, what have you read recently that you have loved?

RP and LV: Dorothy Sayers’ mystery novels, Don Quixote in Liubimov’s Russian translation, The Collected Stories of Lydia Davis, the essays of Eliot Weinberger (Oranges and Peanuts for Sale and An Elemental Thing), the journals of Kornei Chukovsky, Guido Ceronetti’s La Pazienza dell’arrostito (The Patience of the Roasted), Martin Chuzzlewit

Bitter Pill: The Modern Medicine Lament

“My Best Friend, my doctor, won’t even say what it is I’ve got.”-Bob DylanI recently became aware of a trend, the Modern Medicine Lament, in which American writers struggle to make an uneasy peace with a system from which they feel alienated. And it begs the question: has it always been this way?Doctors have enjoyed a colorful depiction in books and letters over the years. Kafka’s brilliant short story “A Country Doctor” is still read and taught frequently. Boris Pasternak’s Dr. Zhivago was a man of principle in any language, in any time. Chekhov was a trained physician. I should also mention my favorite doctor in literature, Dr. Livesey, from Robert Louis Stevenson’s Treasure Island. Stevenson, you’ll recall, sketched another doctor, Dr. Jekyll, whose enthusiasm for chemicals took him off the rails (if Jekyll lived in America today he would surely declaim in a basement recovery meeting about the social transgressions committed by his intoxicated self). Mary Shelley’s Frankenstein, written almost 200 years ago, offers a remarkable foreshadowing of the moral and ethical challenges inherent to the practice of medicine, which has always had one ultimate goal: triumph over death. It is telling that we will in passing mistake the name of the title character for that of the monster.In 1885 Louis Pasteur, a Frenchman, first administered vaccine to a human, a child bitten by a rabid dog. The treatment was successful. It was not an insignificant moment in human history. Giant scientific leaps forward like Pasteur’s continue to inject health and medicine into the lives of everyday people. Vaccines and antibiotics changed the world, though today their administration is practically mundane. In America, where good health has always been considered something of a birthright, we resent doctors. They are a necessary evil, a reminder of the basic infirmity of our bodies and the inevitability of their decline. Sure, Americans love watching fictional doctors treat fictional patients on television, but in reality aren’t doctors society’s consummate whipping boys? After all, that goal – sticking it to death – has never yet been achieved. Good news from a doctor cannot amount to more than “you will live for maybe a few more years, all things being equal.” And anyway, Americans don’t want to live forever, they simply want their life on earth to be pain-free, and believe it should be.Pills that govern the chemical workings of the brain are now at the forefront of our ever-advancing medical knowledge. They treat disorders like depression, schizophrenia, autism, addiction, panic, mania, and garden-variety anxiety. Neurochemistry remains the least understood field in medicine, but the sales figures of these drugs have exploded in the past twenty years. Pharmaceutical manufacturers employ direct advertising – and also work more quietly through doctors – to encourage the public to treat a psychological condition far enough from bliss as a disorder. Comparatively little attention is paid to the fresh array of stresses and overload of stimuli that burden the modern brain, and how these factors can capitalize on the ease of modern life, where we are at greater leisure to explore exactly how we feel, as opposed to wasting all of our energy on mere survival. Effexor, Wellbutrin, Paxil, Zoloft, Prozac: ugly mash-ups, yes, but also household words. The drugs have brought relief to millions of people suffering from mental duress.But the rise of Psychotropic Nation has created a cultural preoccupation with pills here in the U.S., one that has in turn given rise to questions about the efficacy of our medical system (actually just one of many aspects of our system that provoke such questions). If you are writing a novel, say, and wish to introduce recreational drug use into the plot (you may want the characters to seem more subversive, irrational, hedonistic, or edgy), you might shy away from the ho-hum world of schedule 1 drugs: your pot, your cocaine and heroin – in favor of those that can be obtained with a doctor’s note: pain pills, sedatives, amphetamines. The irony payoff is just too great, and writers love irony. The companies that make these drugs want you to want them, but as soon as you do, you probably should not have them. And maybe you, the writer (or the characters for that matter), don’t have health insurance, or went through a period when you weren’t covered – that just adds to the irony. Without insurance you’re not seeing a doctor, making it a whole lot easier for you to go schedule 1 than to buy a bottle of valium. And, given the cost of such pills, cheaper too.Jonathan Franzen wrote extensively on this aspect of American life (see also Ben Kunkel’s Indecision, in which psychopharmacology plays no small roll). In The Corrections the drug is called Aslan, and its effects are somewhere between Prozac and ecstasy. At least two Lamberts use the drug, Chip during an unfortunate weekend sex binge, and Enid, Chip’s mother, whose little helper gets her rather strung out over a longer period. Franzen’s treatment is made more complete as Gary, eldest of the Lambert kids (and hilariously aware of the ebb and flow of his own serotonin and dopamine levels) invests money in the drug company that makes Aslan. Meanwhile, the pill is pushed by a leonine doctor with a creepy, guru-like aspect. And, of course, the one individual who could really use a pick-me-up, the crushingly depressed father Alfred, gets none. Collective dysphoria has never been so amusing.Life imitates art, but it’s no barrel of laughs. That said, the cover story of this month’s Harper’s, “Manufacturing Depression: A Journey into the Economy of Melancholy”, by Gary Greenberg, does deliver the odd ironic chortle. Mr. Greenberg, a psychotherapist, is writing a book about the “misuses of medical diagnoses,” and if his magazine piece is any indication, it may be worth reading. The piece opens with Mr. Greenberg cataloging the failures and dissatisfactions of his life to a kindly psychiatrist, Dr. George Papakostas, in order to see if he qualifies for an experimental drug study at the Depression Clinical and Research Program of Massachusetts General Hospital. And, after checking some boxes, the doctor delivers his diagnosis: Mr. Greenberg has Major Depression. Would he like to try Celexa, Lexapro, Mirapex, or omega-3 fish oil?”It was hard to believe that Papakostas really thought I had major depression,” writes Mr. Greenberg. Mr. Greenberg does feel bad sometimes, inadequate, feckless, and yes, his hair is thinning. His life is not blissful. But what is made abundantly clear to him is that the clinical criteria for a diagnosis of Depression, codified in the psychiatrist-developed Structured Clinical Interview, are bunk. Your score on this questionnaire, determined by the doctor, is totally subjective, the questions laughably interpretive. Dr. Papakostas, looking for subjects for a drug study driven by new medicines from Forest Laboratories, Inc. and paid for by the federal government, is predisposed towards a diagnosis of Clinical Depression. That’s really what someone looking to join such a study wants to hear, right? “‘Are you content with the amount of happiness that you get doing things that you like..?'” It is a standardized question asked by the doctor at one of Mr. Greenberg’s weekly follow-ups. “‘I’m not big on contentment,’ I said. Is anyone? I wondered. Is anyone ever convinced that his or her pursuit of happiness has reached its goal? And what would happen to the consumer economy if we began to believe that any amount of happiness is enough?”The uncomfortable intersection of the consumer economy and medicine is at the heart of an article by Bruce Stutz that appeared in the May 6 issue of the NY Times Magazine. Unlike Mr. Greenberg, who never believes that he is clinically depressed even as he dutifully takes his Mass General fish oil, Mr. Stutz begins from a different point of view: he, like millions of Americans, went through a period of debilitating depression for which he sought medical treatment. Talk therapy and a prescribed selective serotonin reuptake inhibitor, Effexor, worked for him. Three years and a more positive outlook on life later, Mr. Stutz found himself shaking hands with his psychiatrist at the conclusion of his final session. But there was no mention of going off the drug.”Somehow I couldn’t believe I had to take this pill for the rest of my life,” he writes. How many people taking such medication have had that thought? It’s not just the side effects, the occasional bouts of impotence, the weight gain, the dulled sensory perceptions and emotions, and it’s not just the monetary cost of the pills. It is also living with a stigmatizing reminder that one is sick and will never be well. But Mr. Stutz was well: he felt better; he was able to go one with his life. The stresses that had predicated his mental slide, the death of a parent, the breakup of a marriage, the loss of a job, were in the rearview. So he tapered his meds and hunkered down. Fierce withdrawal symptoms followed: mental torpor, physical discomfort, and the frightening “brain zaps,” blinding, incapacitating insta-headaches. With the help of some experts in clinical biology, Mr. Stutz does an admirable job of elucidating the chemical processes that were at work in his brain, which was, without the help of the meds, running a serotonin deficit. What Mr. Stutz did not experience during that period was a return of his depression symptoms. And so he wonders, “does our long-term reliance on these drugs become more of a convenience than a cure?”Drug companies and doctors have about as much interest in helping people go off their psych meds as tobacco execs have in helping people quit cigarettes. Still, the medical industry is simply giving us what we want, a quick fix. What happens when the quick fix goes bad? The title of Ann Bauer’s May 18 article on Salon.com, “Psych Meds Drove My Son Crazy”, is inelegant but to the point. Her story is gripping, horrifying, and ultimately infuriating. Mrs. Bauer’s eldest son was born with autism. At the age of 17 this highly functional kid living in Minnesota became depressed, and his mother took him to a psychiatrist who prescribed an anti-depressant, which, she was assured, would not only snap him out of his funk, but also help control some of his autism-related obsessive tendencies. Instead, his condition grew worse. Doctors at a “respected neuropsychology clinic” reevaluated Mrs. Bauer’s son, now 30 pounds heavier and sleeping 16 hours a day, and changed the original diagnosis: in addition to his autism, her son was experiencing “‘psychomotor slowing’ – a form of schizophrenia.” And so a different drug was prescribed, Abilify, which was new (and, Mrs. Bauer notes, had been marketed direct-to-consumer in Time and Newsweek). Still her son’s condition worsened, “humming, shifting foot to foot, screaming if anyone touched him or tried to move him.” He would dialogue with voices that Mrs. Bauer could not hear. She tapered him off the Abilify.Two days later he “got out of bed and stood in one place for a solid hour.” When Mrs. Bauer placed a hand on him, he beat her up.Amazingly, the doctors managed to convince Mrs. Bauer to try yet another drug, a powerful anti-psychotic, Geodon. Her son took to living on the street after that. Only by conducting her own research, and getting a lucky referral to the Mayo Clinic from a retired doctor in Stony Brook, N.Y., an expert in a little known condition called autistic catatonia, did Mrs. Bauer find her son proper medical care. It took two years. Five days after checking him into Mayo, Mrs. Bauer read a front-page story in the NY Times “about psychiatrists in Minnesota who were collecting money from drug manufacturers for prescribing atypical antipsychotics, including Abilify and Geodon.” The article cited some hefty payout numbers, and also some serious risk factors for the drugs. It did not mention a fact that the doctors at Mayo confirmed: administered to an individual suffering from autistic catatonia, which they determined was the root cause of her son’s initial decline, neuroleptics like Abilify and Geodon only amplify the effects of the disorder, and they can cause permanent neurological damage.She doesn’t say so, but I really hope Mrs. Bauer sued the pants off some folks. I would be interested to know.There will be more Modern Medicine Laments to come. We will read them, and we will also watch with interest TV shows like “The Sopranos”, in which the writers have taken an increasingly critical line on the treatment of depression in America, and films like Michael Moore’s upcoming documentary about the ills of the American health care system. We will see more legal settlements against drug manufacturers like Purdue Pharma (OxyContin) and Pfizer (Celebrex) for misrepresenting the effects of their products to the consumer public. And, of course, we will continue to pop pills. We are a nation of armchair doctors. Sometimes it seems like a prescription pad is the only thing separating us from the real thing.Update: The Libra in me desires balance. I do not want this post to seem an ad hoc dismissal of the medical profession as a whole. So I would steer folks to a book, Mountains Beyond Mountains, by Tracy Kidder, that had a profound impact on me when I read it. The book is about Dr. Paul Farmer, whose work battling T.B. while bringing basic medical care to corners of the world like Haiti and Peru where none existed before makes him something of a medical superhero. Kidder’s profile of Dr. Farmer proves that modern medicine is still changing the world for the better.

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