IAHPC Book Reviews

2020; Volume 21, No 6, June

IAHPC Book Reviews

Note for authors and publishers
If you wish to have your book reviewed, please send it to:

Dr. Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084

Palliative Care Book of the Month

BEFORE AND AFTER LOSS: A Neurologist’s Perspective on Loss, Grief, and Our Brain

Lisa M. Shulman
Johns Hopkins University Press, 2018
163 pp, softcover
Also available: e-book
ISBN 978-1-4214-2695-2
RRP $US19.95 £12.75 $AU44.99
Review copy supplied by Footprint Books.

This book is about the grief and bereavement experienced by Shulman after the death of her husband (also a neurologist) in 2012, using what the scientists know about how the mind, brain, and body respond and heal after traumatic loss.

“I expected grief to be unbearable sadness, but it wasn’t that at all. It was profound instability. Losing bearings, losing identity, losing your coherent self. Where life is distorted, spooling out in a surreal string of events. Where sorrow is expected, and altered reality arrives.”

The first three chapters The Before Life describe her husband’s illness and their reactions to it.

The After Life comprises the bulk of the book and is divided into two sections: grief and loss, and healing and restoration. In the first, she relates some of her own experiences after her husband’s death and summarises what is known about the neurology of grief. She refers to complicated grief, chronic traumatic encephalopathy (CTE), and post-traumatic stress disorder (PTSD). There is an interesting chapter on dreams and dream interpretation. This is followed by discussions of the science of the wounded mind (“Beset by unfamiliar emotions, we may question if we’re losing our mind”), and the science of the wounded brain, which delves into a number of areas, from fMRI changes caused by grief to the takotsubo syndrome (also known as broken heart syndrome). The second part starts with a discussion of our responses to the solitude of grief and loss, such as immersion or distraction. There is a chapter on journaling as a tool of emotional healing, followed by a summary of nontraditional and traditional therapies. The final chapter is about emotional restoration.

There is a six-page bibliography and an index.

This is one of the better accounts of grief and bereavement that I have seen, possibly because it includes a reasonable dose of neurological and psychological science. Anyone who works in palliative care and has an interest in grief and bereavement will both enjoy and benefit from reading this book.

Lisa Shulman is a Professor of Neurology at the University of Maryland.

(Roger Woodruff, May 2020)

Other Reviews

THE MEDICINE: A Doctor’s Notes

Karen Hitchcock
Black Inc, 2020
249 pp, softcover
Also available: e-book
ISBN 978-1760641931
RRP $AU29.99 $US16.99 £13.60

This book was a pleasure to read. Karen Hitchcock is a specialist physician in general medicine (“general internist” in American parlance) who works in Melbourne. Here are 50 short essays that touch on many aspects of medicine and medical practice. And before I forget, she had a PhD in English before she took on medicine, which may explain why I found her writing both interesting and readable.

The essay on euthanasia The Right to Die or the Right to Kill? is alone worth the cost of the book. Using terms like euthanasia and assisted suicide (in preference to the other euphemisms), she debunks the clinical lies and slogans of the pro-euthanasia lobby. And there is a special serve for Andrew Denton, the former comedian turned national identity for the assisted dying movement, who boasted a whole eight months’ research before going public with his convictions, with which (of course) no rational person could disagree.

Big Pharma comes under the spotlight in a number of the essays. Inadequate research of new products, misleading advertising, and putting profit first are some of the issues raised. Megadoses of vitamins for which there is no documented benefit get a mention; the worldwide sales of vitamins and other supplements apparently amount to US$68 billion.

Palliative care is specifically mentioned in the management of the elderly and those with failing health. But many of the clinical issues discussed are relevant to palliative care, including complex medical cases with multiple chronic conditions, optimising communication, listening properly, what holistic care really means, and much more. Hitchcock is one of the first authorised prescribers of medicinal cannabis in Australia and I found her discussion of the medicinal use of cannabis, which does cross the path of palliative care, most interesting. She takes an open-minded stance about cannabis — as well as the use of psychedelic substances to treat a variety of affective disorders — that once properly researched, these drugs may be of great value in the future.

And there’s a lot more. Legislative politics, institutional politics, sexism in the medical workplace, and alternative or integrative medicine, just to mention a few. She even discusses her own (former) nicotine addiction. I think that any doctors or nurses working in palliative care will find this book interesting, thought-provoking and enjoyable.

(Roger Woodruff, May 2020)

SPIRITUALITY AND MEANING MAKING IN CHRONIC ILLNESS: How Spiritual Caregivers Can Help People Navigate Long-term Health Conditions

Kelly Arora
Jessica Kingsley Publishers, 2020
221 pp, softcover
Also available: e-book
ISBN 978-1-78450-996-5
RRP $US17.00 £18.99 $AU44.99
Review copy supplied by Footprint Books.

This book is for professional spiritual care providers, social workers, and health care professionals who care for people affected by incurable disease. In her description of the elements of spirituality and spiritual care, she analyses the story of Dorothy and The Wizard of Oz as well as her own personal narrative of dealing with rheumatoid arthritis.

The book has six chapters. The Calm Before The Storm serves as an introduction to her vocabulary. Her description of “wholistic” care includes attention to physical, psychological, spiritual, and social matters, but there is no mention of cultural issues. She later writes about intercultural spiritual care, but this is a reference to the diversity of spiritual beliefs and not the suffering due to cultural issues per se. The Wicked Witch of the West is about illness and meaning making, including the moral, biomedical, social, and energy body models. The Yellow Brick Road is about losses and the responses to them that may occur along the way, including depression, demoralization, and a desire for hastened death. Scarecrow, Tin Man, and Lion is about spiritual struggles and the various styles of spiritual coping. The Wizard of Oz offers guidance about healing relationships. Glinda and the Return to Kansas is about meaning making later in the disease course and dealing with the new normal.

In her discussion about assisted dying, she quotes a paper by Wilson et al that showed “less than 10%’ of patients would request it if it were legal”; in fact, there were 2 papers from that group of researchers that reported only 6 and 8% of terminally ill cancer patients would think about requesting assisted death. And what about Oregon? There have been about 150,000 deaths from cancer in the 20 years since the Dying with Dignity Act began. If 35% of the adult population voted in favour of assisted dying (which amounted to 51% of votes cast on the day), that should have resulted in 52,500 assisted deaths from cancer alone. The score so far? 867.

I found some of her terminology a distraction and was not particularly comfortable with terms such as a hero’s journey, a spiritual orientating system, a web of life, and illness-in-the-foreground (IITF). And I was told that “sacred” was a term coined by someone in 1997! In several places she refers to her mnemonic, SNAP, which stands for Self awareness (know yourself so you do not impose your views), stay in the Now (keep focused in the present moment and on the care receiver), Ask questions, and let the other Person guide the conversation. I would probably come up with similar goals, but quite differently expressed. And finally, using Dorothy and The Wizard of Oz as a metaphor for chronic illness did not work for me. What you get is a detailed 21st century psychological analysis of every detail of an innocent fairy tale written in 1899. Did the Wizard intentionally and knowingly employ the placebo effect when treating Tin Man, Scarecrow, and Lion?

There is a 33-page bibliography as well as a glossary and index.

If you have interests in the spiritual aspects of palliative care, you should read this book. I did not find it easy to read, particularly with regards to her terminology and the use of the Oz metaphor, but perhaps that is my problem.

Kelly Arora, PhD, is Assistant Clinical Professor at the University of Colorado Anschutz Medical Campus, and Senior Adjunct Lecturer in Spiritual Care at the Iliff School of Theology.

(Roger Woodruff, March 2020)

DEATH, RELIGION AND LAW: A Guide for Clinicians

Peter Hutton, Ravi Mahajan, and Allan Kellehear
Routledge, 2020
324 pp, softcover
Also available: e-book
ISBN 978-1-138-59289-6
RRP  £33.28 $US53.95

This book is written because the authors believe that there is a need to improve the information related to, and the teaching of, the process of managing death. In the preface it says the book is written for doctors, nurses, and social workers, and it struck me as curious that people working in chaplaincy and the field of pastoral care were not specifically included in the list.

The book is in three parts. The first, entitled Belief systems in society and human history: interpretations of the mysteries of life and death looks at the basis for faith and belief, including secular beliefs, throughout history. There are discussions of the characteristics of a religion or belief system, the range of belief paradigms, the nature and existence (or not) of the soul, and what death means to patients and their relatives. The information provided was most interesting for its own sake, but I was uncertain if it was going to improve my bedside performance in the palliative care ward.

The second part, Managing death in different faiths and doctrines, outlines the important issues related to death and dying of the major religions, all 13 of them. These chapters provide a description of the religion, care of the dying, management of death, and implications regarding autopsy and organ transplantation. Having access to this information would be helpful when dealing with people with religious beliefs that you are not familiar with. But there are sects and subsects, and beliefs may vary amongst people in the same family, meaning no two people saying they belong to a particular religion will necessarily have identical beliefs. So the information here is more by way of background and general guidance.

The third part is Legal aspects of death in the UK. This provides discussion about the biological and legal constructs of life and death, and the medico-legal issues at the end of life including certification, autopsies, the disposal of the body, and brain death/transplantation, as they apply in the UK. The authors warn there have been many changes in these regulations over the last few years.

It would be useful to be able to refer to this book if one were confronted by a patient or family espousing a religion with which you were not familiar, or if you ran into medico-legal problems with the regulations in the UK.

Peter Hutton was Professor of Anaesthesia at Birmingham University before moving to the Royal Brompton and Harefield Hospitals. Ravi Mahajan is Professor of Anaesthesia and Intensive Care at the University of Nottingham. Allan Kellehear is a Professor in the Faculty of Health Studies at the University of Bradford.

(Roger Woodruff, May 2020)

Roger Woodruff, MD (Australia)
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.

NB: Review copies become the property of IAHPC and are not returned to the author. Only books related to palliative care that have been approved and have an ISBN will be reviewed. Due to the large number of requests, we cannot provide exact dates of when books will be reviewed.

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