Arts & Literature And Nature (ALAN)

In this issue, ALAN features a brief composite review of two memoirs by Polina Anang. The books address the authors’ personal psychotherapy experiences from the service user and provider’s perspectives. John McLennan presents Magawa, a different type of service animal, and the consequences of wars, such as Landmines. We wish to mention that the Magawa article was submitted before the war in Ukraine broke out; however, there is no better time for reflection on the adverse effects of wars. Finally, Lind Grant-Oyeye provides an overview of “Unsafe,” a poetry book featuring themes of Childhood Adverse Events.

From The Child and Adolescent Psychiatrist’s bookshelf: “Maybe You Should Talk to Someone”, “Group”

Book Review by Polina Anang

The University of Manitoba residency program has had a strong history of psychotherapy training in both General Adult and in Child & Adolescent psychiatry (CAP). I enjoyed excellent teaching while completing my CAP training in Winnipeg. However, I often found the academic reading dry, hard to digest, and unappealing. This has spurred me to explore more enjoyable and varied reading experiences for residents I am currently supervising in psychotherapy, and I keep going back to our local independent bookstore to replenish my give-away library, currently including of “Group” by Christie Tate and “Maybe You Should Talk to Someone” by Lori Gottlieb (1).

In “Maybe You Should Talk to Someone” Gottlieb relates the stories of her patients in what is a delightful book for psychiatry trainees specifically because it is NOT a textbook. It touches deftly on psychotherapy concepts, historic figures, and formulations. The complexities and nuances of the trade are easily unpacked and translated for non-professional readers into a narrative that is crisp, playful, and enchanting. What could be a more enthralling story than an open-minded, self-aware therapist using merciless humour and self-deprecating storytelling to illustrate the point that therapists make lousy patients. Gottlieb convincingly wraps us around her finger sharing the trajectories of patients she had been able to help. You learn about countertransference, self-objects, resistance, projective identification with ease and grace through the unravelling of the patients’ narratives. Woven into this poignant unfolding of psychotherapy in real time is a counternarrative. Gottlieb’s private life itself is falling apart, and she takes us along for a bumpy ride. She is brutally honest about her hesitations and deliberations while searching for a therapist herself, and then equally honest in observing and reflecting on the therapist who treats her. The contrast between a masterful therapist and an avoidant, resistant, dismissive patient combines into a book that is both hilarious and excruciating. Our professional psychotherapeutic concepts come alive and are displayed in a simple and intuitive way – I will continue to derive happiness from donating a copy to every learner who is curious about psychotherapy.

In “Group” Tate is both author and patient in a magnificent story about a “crazy” psychiatrist. I use the word “crazy” deliberately, encompassing disbelief, idiosyncrasy, rule-braking, and bewilderment. While “Group” is entertaining, it is simultaneously courageous (2). It is one woman’s review of progress in psychotherapy, highlighting the power of genuine relationships, therapeutic and otherwise. Tate’s psychiatrist is refreshingly unorthodox, although the book should come with the warning “Do not try this at home”. The author’s entrance and descent into the psychotherapy experience is full of intensity, distortions, and projections, and I can list a thousand ways of how this could go wrong. But for Tate this group treatment – and most of all her therapist’s advice to join one more group if you are falling apart – is described as life saving. She ends up in three group sessions per week, while maintaining a busy career as a lawyer. One of the reasons I would like learners to read this book is to resist using the DSM label “Borderline” when describing a struggling young woman. Tate teaches us how to focus on the core human complexities of intimacy, trust, and hurt. She is a brilliant storyteller, and her devotion to her idiosyncratic therapist makes him appear at once glorious and inherently fallible.

I see “Group” and “Talk to Someone” as complementary to more comprehensive psychotherapy textbooks. Tate’s and Gottlieb’s effortless inspirational storytelling makes a compelling argument for learning psychotherapy in the context of learning to be self-aware. While psychiatric training is shifting towards psychopharmacology, biomedical and metrics-driven approaches, it is important to remember how much our profession owes to relationship building, acceptance, and introspection. When you read these two books, you will be reminded why you might have chosen psychiatry – or any other field of work that exposes you to the dialectic of human suffering and hope.

Polina Anang is a child and adolescent psychiatrist based in Winnipeg, Manitoba.

The Nature of Service: Rats Identifying Landmines

A photo of a rat with a gold medal about its neck caught my eye as I scrolled through BBC news highlights. The rat was Magawa, an African giant pouch rat from Tanzania, who had recently died (1). Magawa, and others of his kind, have been successfully trained to detect landmines to allow their safe removal. In his lifetime, Magawa alone detected more than 100 landmines in Cambodia. Reportedly such rats can cover large swaths of land in short periods of time. Magawa was allowed to retire and then died at eight years of age. For his service, Magawa received a prestigious animal bravery award (https://www.youtube.com/watch?v=AeT4ZVRjZ4E).

I enjoyed the fact that a rat was being recognized as a type of service animal, not typically the first animal that comes to mind for such a role. I was also relieved to hear that given their relatively light weight, these rats do not trigger the mines they find. I also learned they are trained through positive reinforcement techniques (2), avoiding the graver fate of their cousins enrolled in medical research. Underpinning the cute (yet absurd) photo-op of a large rodent wearing a gold medal, however, is the disturbing need for such service animals, to address the countless landmines left after the wars of Homo sapiens.

It is estimated that there is one mine for every 50 people on the planet (3). A report from the International Campaign to Ban Landmines estimated that al least 2,492 people were killed and 4,561 injured by landmines in 2020, a substantial increase from 2019 (4). The majority of victims were civilians and as many as one-half were children, with disproportionate maiming and killing of the rural poor (4). The ongoing Syrian tragedy claimed the most recorded casualties in 2020 (4).

The adverse impacts of landmines and unexploded ordinances extend beyond the direct maiming and killing, and include the alteration of Homo sapiens’ use of, and relationship with, the land. Arensen captures this in a summary of her study of a Cambodian community, “Village residents and government deminers were attempting to recreate the pre-war world of agricultural bounty but the presence of military waste rendered the landscape into a new ecosystem, an entangled zone of organic elements and potentially hazardous inorganic ones” (p.12) (5). In addition, a study from Lebanon linked food insecurity with loss of agricultural land to landmines (6). Further impacts include the loss of livestock (7).

Conventions have been developed in an attempt to address the landmine problem (e.g., Ottawa Convention on Landmines (8)) and some progress has been made in landmine removal. However, until there is an outright ban on landmines and a greater investment in cleaning up the current mess, we will continue to need Magawa and other service animals to engage in unnatural behaviours to rectify our corruption of the earth’s surface.

John D. McLennan is a child psychiatrist based in Calgary.

“Unsafe”: A Reflection on Poetry and Adverse Life Events

Landmines, bullets, and shrapnel are all reminders of war and the chaos it unleashes. Tragically, many recipients of the turmoil of war are not key players directly involved in the battle. Rather, many vulnerable individuals such as children become casualties, caught in the crossfire. Literary images and metaphors of “war” have, over generations, been meaningfully used to represent family-based violence which also has its unintended casualties.

Geraldine O’Kane, in her debut full-poetry collection Unsafe, published in 2021 by Salmon Poetry (1), builds on and grows a literary tradition of mirroring family violence and war. The foundation of her collection is the story of a child traumatized by childhood events, an acrimonious and toxic parental divorce, and intimate partner violence.

Presented from the perspective of an adult who experienced childhood trauma, O’Kane creates vivid images of the impacts of family trauma. In the string of connecting haikus “While I remember,” the emotive use of the phrase, “in their divorce I was the Shrapnel” invites the reader to reflect on the reality of conflicts, whether at home or in the larger society. Oxford Languages defines shrapnel as “fragments of a bomb, shell, or another object thrown out by an explosion.” (2). I wonder whether “Shrapnel” in this context refers to the youth as a weapon of family warfare or a fragment, shattered and shattering.

Unsafe is not restricted to descriptions of a toxic parental relationship. Sexual trauma and grief, and other themes are also explored. For example, “Playtime” recounts a traumatic memory around sexual abuse, and “Then We Were Four” speaks to the loss of a sibling.

Cultural taboos, such as silence relating to intimate partner violence experience, are also laid out. In “Stark,” a person depicted as the victim of violence declares, “it never happened, no, it never happened.” The preceding lines suggest the individual was either using the defense mechanism of denial or pre-contemplative regarding their personal experience of violence and possible action.

As a mental health provider working with many youths with “Adverse Childhood Experiences” the reflections on trauma herein resonated strongly. The poem “Today, I brought you a gift, free of cages, my words wrapped in an everlasting voice, a poem for you” also represented to me a gift of connection and clarity.

O’Kane does not speak directly to the origins of themes of this work, whether autobiographical or not, but in an interview with Colin Daris (3), she suggested that she usually writes from experience. Nevertheless, regardless of origins, O’Kane has successfully provided a powerful and intimate account of the experience of symbolic family-based warfare. Some readers may find some descriptions of trauma occasionally too explicit; however, stories of trauma cannot always be wrapped in nuance.

Lind Grant-Oyeye is a child and adolescent psychiatrist in New Brunswick.